摘要
目的评估内镜超声检查(endoscopic ultrasonography,EUS)在十二指肠乳头癌术前分期和导管扩张中的诊断价值,分析其诊断准确度的影响因素。方法采用横断面研究设计,收集2018年1月至2023年8月于本院消化内科就诊且经病理诊断为十二指肠乳头癌并接受EUS的患者,采用灵敏度、特异度、阳性预测值、阴性预测值和准确度评价EUS对十二指肠乳头癌术前分期的诊断价值。单因素和多因素分析确定影响EUS诊断准确度的因素。结果本研究共纳入102例经病理诊断确诊为十二指肠乳头癌的患者,其中男性59例,女性43例。患者平均年龄为62岁。患者确诊前均接受EUS,EUS对肿瘤T分期的准确度为86.27%,对T1、T2、T3、T4病变的灵敏度和特异度分别是84.21%、92.31%、85.00%、60.00%和95.31%、88.89%、96.34%、98.97%。T1、T2、T3、T4病变T分期的阳性预测值分别为91.43%、83.72%、85.00%、75.00%,阴性预测值分别为91.04%、94.92%、96.34%、97.96%。有14例患者的T分期被EUS错误分期。EUS评估导管内扩张的准确度为75.49%,对导管扩张的敏感性、特异性、阳性预测值和阴性预测值分别为96.97%、66.67%、98.97%、40.00%。EUS对胰管扩张诊断准确度的独立预测因素为神经浸润、肿瘤大小和T分期;而对胆管扩张诊断准确度的独立危险因素为神经浸润和碱性磷酸酶。结论EUS对十二指肠乳头癌术前分期诊断价值高,神经浸润、肿瘤大小、T分期、碱性磷酸酶可能是其诊断准确度的影响因素。
Objective To evaluate the diagnostic value of endoscopic ultrasonography(EUS)in the preoperative staging and ductal dilatation of duodenal papillary carcinoma and analyze the factors influencing its diagnostic accuracy.Methods A cross-sectional trial was conducted on the patients with pathologically-diagnosed duodenal papillary carcinoma and undergoing EUS in the First Affiliated Hospital of Army Medical University from January 2018 to August 2023.The diagnostic value of EUS for the preoperative staging of duodenal papillary carcinoma was evaluated using sensitivity,specificity,positive predictive value,negative predictive value,and accuracy.Univariate and multivariate analyses were performed to determine the factors affecting the diagnostic accuracy of EUS.Results A total of 102 patients with duodenal papillary carcinoma were included,including 59 males and 43 females,at a mean age of 62 years,and all of them underwent EUS before diagnosis.The accuracy of EUS for tumor T-staging was 86.27%,the sensitivity and specificity for T1,T2,T3,and T4 lesions were 84.21%,92.31%,85.00%,60.00%,and 95.31%,88.89%,96.34%,and 98.97%,respectively.The positive predictive value for T-staging of T1,T2,T3,and T4 lesions was 91.43%,83.72%,85.00%,and 75.00%,and the negative predictive values were 91.04%,94.92%,96.34%,and 97.96%,respectively.There were 14 patients whose T-staging was incorrectly staged by EUS.The accuracy of EUS in assessing intraductal dilatation was 75.49%,and the sensitivity,specificity,positive predictive value,and negative predictive value for ductal dilatation were 96.97%,66.67%,98.97%,and 40.00%,respectively.In addition,the independent predictors of diagnostic accuracy of EUS for pancreatic duct dilatation were nerve infiltration,tumor size,and T stage;whereas the independent risk factors for diagnostic accuracy of bile duct dilatation were nerve infiltration and alkaline phosphatase.Conclusion EUS has quite higher diagnostic value for preoperative staging of duodenal papillary carcinoma,and nerve infiltration,tu
作者
杨佳
王梓义
陈磊
张耀
陈静
高莉萍
冯晓峰
YANG Jia;WANG Ziyi;CHEN Lei;ZHANG Yao;CHEN Jing;GAO Liping;FENG Xiaofeng(Department of Gastroenterology,First Affiliated Hospital,Faculty of Military Preventive Medicine,Army Medical University(Third Military Medical University),Chongqing,400038,China;Department of Army Epidemiology,Faculty of Military Preventive Medicine,Army Medical University(Third Military Medical University),Chongqing,400038,China;Department of Plastic Surgery,First Affiliated Hospital,Faculty of Military Preventive Medicine,Army Medical University(Third Military Medical University),Chongqing,400038,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2024年第22期2561-2568,共8页
Journal of Army Medical University
基金
重庆市卫生适宜技术推广项目(2023jstg005)。
关键词
内镜超声检查
十二指肠乳头癌
准确度
影响因素
endoscopic ultrasonography
uodenal papillary carcinoma
accuracy
influencing factors
