超声内镜检查术联合腹部CT鉴别胰腺占位性病变的价值

Value of endoscopic ultrasonography combined with abdominal CT in differentiating pancreatic space occupying lesions

摘要:

目的 分析超声内镜检查术（EUS）联合腹部CT鉴别胰腺占位性病变的价值。方法 选取2020年5月－2023年5月该院收治的胰腺占位性病变患者120例，分为良性组（n = 41）和恶性组（n = 79）。比较两组患者病变类型、EUS、腹部CT、联合检查和病理检查结果，绘制受试者操作特征曲线（ROC curve），探讨EUS、腹部CT和联合检查对胰腺占位性病变良恶性的鉴别价值。结果 与良性组比较，恶性组病变直径 > 2 cm比例更高，差异有统计学意义（P < 0.05）。良性组中，黏液性囊腺瘤7例，神经内分泌肿瘤15例，浆液性囊腺瘤8例，乳头状黏液性肿瘤5例，胰腺实性假乳头状瘤6例；恶性组中，胰腺癌60例，胰腺导管腺癌11例，胆管腺癌8例。EUS、腹部CT和联合检查准确诊断恶性胰腺占位性病变分别为68、53和75例。将恶性纳入阳性，良性纳入阴性，绘制ROC curve，分析EUS、腹部CT和联合检查对胰腺占位性疾病的鉴别价值，曲线下面积（AUC）分别为0.833、0.653和0.913，敏感度分别为86.08%、67.09%和94.94%，特异度分别为80.49%、63.41%和87.80%，联合检查均最高。结论 恶性胰腺占位性病变直径 > 2 cm比例更高，EUS联合腹部CT诊断胰腺占位性病变良恶性，具有较好的鉴别价值，可为疾病的早期诊治提供指导依据。

Abstract:

Objective To analyze the value of endoscopic ultrasonography (EUS) combined with abdominal computed tomography (CT) in differentiating diagnosis of benign and malignant pancreatic space occupying lesions.Methods From May 2020 to May 2023, among of 120 patients with pancreatic space occupying lesions were selected, 41 benign cases were included in the benign group and 79 malignant cases were included in the malignant group. The results of EUS, abdominal CT, combined detection and pathological detection were compared, the differentiating value of EUS, abdominal CT and combined detection in benign and malignant pancreatic space occupying lesions was investigated on the basis of receiver operator characteristic curve (ROC curve).Results Compared with the benign group, the proportion of lesion diameter > 2 cm was higher in the malignant group (P < 0.05). In the benign group, including 7 cases of mucinous cystadenoma, 15 cases of neuroendocrine tumors, 8 cases of serous cystadenoma, 5 cases of papillary mucinous neoplasm, 6 cases of solid pseudopapilloma of the pancreas; In the malignant group, including 60 cases of pancreatic cancer, 11 cases of pancreatic ductal adenocarcinoma, and 8 cases of adenocarcinoma of the bile duct. EUS, abdominal CT and combined detection were used to accurately diagnose malignant pancreatic space occupying diseases in 68, 53 and 75 cases. Malignant was included as positive, benign as negative, and ROC curve was drawn to analyze the differentiating value of EUS, abdominal CT and combined detection in pancreatic space occupying diseases, area under the curve (AUC) was 0.833, 0.653, 0.913 respectively, and sensitivity was 86.08%, 67.09%, 94.94% respectively, the specificity was 80.49%, 63.41%, 87.80% respectively, and the combined detection was the highest.Conclusion The proportion of malignant pancreatic space occupying lesions with diameter > 2 cm is higher, and EUS combined with abdominal CT has a good value in differentiating benign and malignant pancreatic space occupying lesions, which can provide a good foundation for early diagnosis and treatment of the disease.