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Contrast-enhanced harmonic endoscopic ultrasonography for assessment of lymph node metastases in pancreatobiliary carcinoma

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World Journal of Gastroenterology 2016年第12期22卷 3381-3391页

作者： Takeshi Miyata Masayuki Kitano Shunsuke Omoto Kumpei Kadosaka Ken Kamata Hajime Imai Hiroki Sakamoto Naoshi Nisida Yogesh Harwani Takamichi Murakami Yoshifumi Takeyama Yasutaka Chiba Masatoshi Kudo Department of Gastroenterology and Hepatology Kinki University Faculty of Medicine Department of Radiology Kinki University Faculty of Medicine Department of Surgery Kinki University Faculty of Medicine Division of Biostatistics Clinical Research Center Kinki University Faculty of Medicine

AIM: To assess the usefulness of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for lymph node metastasis in pancreatobiliary ***: All patients suspected of pancreatobiliary carcinoma with visible lymph nodes after standard EUS between June, 2009 and January, 2012 were enrolled. In the primary analysis, patients with successful EUS-fine needle aspiration (FNA) were included. The lymph nodes were assessed by several standard EUS variables (short and long axis lengths, shape, edge characteristic and echogenicity), color Doppler EUS variable [central intranodal blood vessel (CIV) presence] and CH-EUS variable (heterogeneous/homogeneous enhancement patterns). The diagnostic accuracy relative to EUS-FNA was calculated. In the second analysis, N-stage diagnostic accuracy of CH-EUS was compared with EUS-FNA in patients who underwent surgical ***: One hundred and nine patients (143 lymph nodes) fulfilled the criteria. The short axis cut-off ≥ 13 mm predicted malignancy with a sensitivity and specificity of 72% and 85%, respectively. These values were 72% and 63% for the long axis cut-off ≥ 20 mm, 62% and 75% for the round shape variable, 81% and 30% for the sharp edge variable, 66% and 61% for the hypoechogenicity variable, 70% and 72% for the CIV-absent variable, and 83% and 91% for the heterogeneous CH-EUS-enhancement variable, respectively. CH-EUS was more accurate than standard and color Doppler EUS, except the short axis cut-off. Notably, three patients excluded because of EUS-FNA failure were correctly N-staged by ***: CH-EUS complements standard and color Doppler EUS and EUS-FNA for assessment of lymph node metastases.

关键词： Contrast-enhanced harmonic endoscopic ultrasonography Sensitivity and specificity Lymph node pancreatobiliary carcinoma Endoscopic ultrasonography-fine needle aspiration

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