Diagnostic Ability of Convex-Arrayed Endoscopic Ultrasonography for Major Vascular Invasion in Pancreatic Cancer
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Background/Aims: This study aimed to examine the diagnostic ability of endoscopic ultrasonography (EUS) for major vascularinvasion in pancreatic cancer and to evaluate the relationship between EUS findings and pathological distance. Methods: In total, 57 consecutive patients who underwent EUS for pancreatic cancer before surgery were retrospectively reviewed. EUSimage findings were divided into four types according to the relationship between the tumor and major vessel (types 1 and 2: invasion,types 3 and 4: non-invasion). We also compared the EUS findings and pathologically measured distances between the tumors andevaluated vessels. Results: The sensitivity, specificity, and accuracy of EUS diagnosis for vascular invasion were 89%, 92%, and 91%, respectively, in theveins and 83%, 94%, and 93%, respectively, in the arteries. The pathologically evaluated distances of cases with type 2 EUS findings weresignificantly shorter than those of cases with type 3 EUS findings in both the major veins (median [interquartile range], 96 [0–742] µmvs. 2,833 [1,076–5,694] µm, p=0.012) and arteries (623 [0–854] µm vs. 3,097 [1,396–6,000] µm, p=0.0061). All cases with a distance of≥1,000 µm between the tumors and main vessels were correctly diagnosed. Conclusions: Tumors at a distance ≥1,000 µm from the main vessels were correctly diagnosed by EUS.
Abstract
Background/Aims: This study aimed to examine the diagnostic ability of endoscopic ultrasonography (EUS) for major vascularinvasion in pancreatic cancer and to evaluate the relationship between EUS findings and pathological distance. Methods: In total, 57 consecutive patients who underwent EUS for pancreatic cancer before surgery were retrospectively reviewed. EUSimage findings were divided into four types according to the relationship between the tumor and major vessel (types 1 and 2: invasion,types 3 and 4: non-invasion). We also compared the EUS findings and pathologically measured distances between the tumors andevaluated vessels. Results: The sensitivity, specificity, and accuracy of EUS diagnosis for vascular invasion were 89%, 92%, and 91%, respectively, in theveins and 83%, 94%, and 93%, respectively, in the arteries. The pathologically evaluated distances of cases with type 2 EUS findings weresignificantly shorter than those of cases with type 3 EUS findings in both the major veins (median [interquartile range], 96 [0–742] µmvs. 2,833 [1,076–5,694] µm, p=0.012) and arteries (623 [0–854] µm vs. 3,097 [1,396–6,000] µm, p=0.0061). All cases with a distance of≥1,000 µm between the tumors and main vessels were correctly diagnosed. Conclusions: Tumors at a distance ≥1,000 µm from the main vessels were correctly diagnosed by EUS.
참고문헌 (28)
- Pancreatric Section, British Society of Gastroenterology, "Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas", Gut, 54(Suppl 5), pp.v1~v16 (2005)
- Warshaw AL, "Pancreatic carcinoma", N Engl J Med, 326, pp.455~465 (1992)
- Jemal A, "Cancer statistics, 2010", CA Cancer J Clin, 60, pp.277~300 (2010)
- Wagner M, "Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma", Br J Surg, 91, pp.586~594 (2004)
- Ahmad NA, "Endosonography is superior to angiography in the preoperative assessment of vascular involvement among patients with pancreatic carcinoma", J Clin Gastroenterol, 32, pp.54~58 (2001)
- DeWitt J, "Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer", Ann Intern Med, 141, pp.753~763 (2004)
- Arslan A, "Pancreatic carcinoma : MR, MR angiography and dynamic helical CT in the evaluation of vascular invasion", Eur J Radiol, 38, pp.151~159 (2001)
- DiMagno EP, "AGA technical review on the epidemiology, diagnosis, and treatment of pancreatic ductal adenocarcinoma. American Gastroenterological Association", Gastroenterology, 117, pp.1464~1484 (1999)
- Rösch T, "The endosonographic staging of pancreatic carcinoma", Dtsch Med Wochenschr, 117, pp.563~569 (1992)
- Megibow AJ, "Pancreatic adenocarcinoma : CT versus MR imaging in the evaluation of resectability--report of the Radiology Diagnostic Oncology Group", Radiology, 195, pp.327~332 (1995)
- Saftoiu A, "Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer", J Clin Ultrasound, 37, pp.1~17 (2009)
- Michl P, "Evidence-based diagnosis and staging of pancreatic cancer", Best Pract Res Clin Gastroenterol, 20, pp.227~251 (2006)
- Dewitt J, "Comparison of endoscopic ultrasound and computed tomography for the preoperative evaluation of pancreatic cancer : a systematic review", Clin Gastroenterol Hepatol, 4, pp.717~725 (2006)
- Nawaz H, "Performance characteristics of endoscopic ultrasound in the staging of pancreatic cancer : a meta-analysis", JOP, 14, pp.484~497 (2013)
- Yang R, "Diagnostic accuracy of EUS and CT of vascular invasion in pancreatic cancer : a systematic review", J Cancer Res Clin Oncol, 140, pp.2077~2086 (2014)
- Puli SR, "Diagnostic accuracy of EUS for vascular invasion in pancreatic and periampullary cancers : a meta-analysis and systematic review", Gastrointest Endosc, 65, pp.788~797 (2007)
- Japan Pancreas Society, "Classification of pancreatic carcinoma" (2017), Kanehara & Co., Ltd.
- Nakata B, "Prognostic predictive value of endoscopic ultrasound findings for invasive ductal carcinomas of pancreatic head", Pancreas, 30, pp.200~205 (2005)
- Yeo CJ, "Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients", Ann Surg, 221, pp.721~731 (1995)
- Tylén U, "Resectability and prognosis of carcinoma of the pancreas evaluated by angiography", Scand J Gastroenterol, 8, pp.691~697 (1973)
- Geer RJ, "Prognostic indicators for survival after resection of pancreatic adenocarcinoma", Am J Surg, 165, pp.68~72 (1993)
- Cameron JL, "Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer", Am J Surg, 161, pp.120~124 (1991)
- Launois B, "Total pancreatectomy for ductal adenocarcinoma of the pancreas with special reference to resection of the portal vein and multicentric cancer", World J Surg, 17, pp.122~126 (1993)
- "ACR manual on contrast media version 10.3" (2017)[URL]
- Buchs NC, "Vascular invasion in pancreatic cancer : imaging modalities, preoperative diagnosis and surgical management", World J Gastroenterol, 16, pp.818~831 (2010)
- Buchs NC, "Vascular invasion in pancreatic cancer : evaluation of endoscopic ultrasonography, computed tomography, ultrasonography, and angiography", Swiss Med Wkly, 137, pp.286~291 (2007)
- Zhang Y, "Preoperative vascular evaluation with computed tomography and magnetic resonance imaging for pancreatic cancer : a meta-analysis", Pancreatology, 12, pp.227~233 (2012)
- Li JH, "Endoscopic ultrasonography for tumor node staging and vascular invasion in pancreatic cancer : a meta-analysis", Dig Surg, 31, pp.297~305 (2014)