南方医科大学学报

南方医科大学学报 ›› 2018, Vol. 38 ›› Issue (10): 1171-.doi: 10.12122/j.issn.1673-4254.2018.10.04

• • 上一篇    下一篇

内镜超声引导下细针抽吸术对胰腺导管腺癌的预测及诊断价值

吴丽权，郭文，李跃，程天明，姚永莉，张亚历，刘碧旋，钟慕晓，李思南，邓秀金，朱薇   

  • 出版日期:2018-10-20 发布日期:2018-10-20

Value of endoscopic ultrasound-guided fine needle aspiration in pretest prediction and diagnosis of pancreatic ductal adenocarcinoma

  • Online:2018-10-20 Published:2018-10-20

HTML

PDF

1216

摘要： 目的探讨预测胰腺导管腺癌（PDAC）鉴别于胰腺其他实性肿瘤病变的因素，评估内镜超声引导下细针抽吸术（EUSFNA） 对PDAC的诊断价值。方法回顾性分析2009年1月~2016年5月南方医科大学南方医院消化内窥镜中心因胰腺占位行 EUS-FNA检查的患者的临床资料，排除诊断不明、资料缺失、重复穿刺、囊性占位病变以及良性病变病例，将患者分为PDAC组 与non-PDAC组，比较两组的EUS-FNA穿刺阳性率，统计EUS-FNA对PDAC诊断的敏感度、特异度、阳性预测值、阴性预测值 和准确率，纳入PDAC组和non-PDAC组患者的人口特征、临床特征、实验室检查和超声内镜成像特征等相关因素进行单因素 和多因素非条件logistic回归分析。结果纳入75例胰腺实体肿瘤病变中，PDAC占72.0%，non-PDAC占28.0%。EUS-FNA诊 断PDAC的敏感度、特异度、阳性预测值、阴性预测值和准确率分别是77.8%、100.0%、100.0%、63.6%、84.0%。PDAC组与non- PDAC组的EUS-FNA穿刺阳性率差异无统计学意义（77.8% vs 76.2%，P>0.05）。多因素logistic分析显示腹痛（OR=5.163，95% CI：1.093~24.389，P=0.038）、病灶性状（OR=7.105，95%CI：1.440~35.043，P=0.016）、病灶大小（OR=0.926，95%CI：0.877~0.978， P=0.006）、病灶转移（OR=6.165，95%CI：1.332~28.533，P=0.020）是预测PDAC的独立影响因子。结论腹痛、病灶转移、病灶大 小和病灶性状的超声内镜成像特征可以可靠地预测PDAC，并且EUS-FNA对PDAC的诊断是具有较高的敏感度和特异度。

Abstract: Objective To identify the predictive factors for differentiating pancreatic ductal adenocarcinoma (PDAC) from other neoplastic solid pancreatic lesions and assess the accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of PDAC. Methods We retrospectively analyzed the clinical data of patients referred for EUS-FNA evaluation of pancreatic lesions in the Digestive Endoscopic Center of Nanfang Hospital between January, 2009 and May, 2016. The cases with unknown diagnosis, missing data, repeated punctures, cystic lesions and benign lesions were excluded from the analysis. The positivity rates of EUS-FNA were compared between patients with PDAC and those with non-PDAC lesions, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS-FNA were assessed in the diagnosis of PDAC. Univariate and multivariate logistic regression analyses were used to identify the factors for differentiating PDAC from non-PDAC lesions based on the demographic characteristics, clinical presentations, laboratory data, and endoscopic ultrasonography imaging features of the patients. Results Among the 75 patients with solid neoplastic pancreatic lesions, 54 (72.0%) were found to have PDAC and 21 (28.0%) had non-PDAC lesions. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA for the diagnosis of PDAC were 77.8%, 100.0%, 100.0% , 63.6% and 84.0%, respectively. No significant difference was found in the positivity rate of EUS-FNA between patients with PDAC and those with non-PDAC lesions (77.8% vs 76.2%, P>0.05). Multivariate regression analysis identified abdominal pain (OR=5.163, 95%CI: 1.093-24.389, P=0.038), lesion size (OR=0.926, 95%CI: 0.877-0.978, P=0.006), characteristics of the solid lesions (OR=7.105, 95%CI: 1.440-35.043, P=0.016), and evidence of metastases (OR=6.165, 95%CI: 1.332-28.533, P=0.020) as the independent factors for predicting PDAC. Conclusion The pretest characteristics including abdominal pain, evidence of metastases, and lesion size and lesion characteristics defined by endoscopic ultrasonography findings can reliably predict a diagnosis of PDAC. EUS-FNA has a high sensitivity and a high specificity for the diagnosis of PDAC.