Endosonographic Diagnosis of Solid Pancreatic Tumors: A Retrospective Analysis from a Tertiary Referral Center

Zusammenfassung

Ziel: Die Endosonografie zum Nachweis von Pankreasraumforderungen ist eine sensitive aber zur Abgrenzung von malignen und benignen Läsionen wenig spezifische Methode. An einem Krankengut mit hoher Prävalenz an chronischer Pankreatitis und Pankreaskarzinom untersuchten wir daher endosonografische Kriterien bezüglich ihrer Korrelation mit der Enddiagnose Pankreaskarzinom. Methodik: 171 Endosonografien mit auffälligem Pankreasbefund und durch Operationsbefund oder klinischen Verlauf gesicherter Diagnose (mediane Nachbeobachtungszeit 41 Monate) wurden retrospektiv anhand von 22 endosonografischen dichotomen Kriterien ausgewertet. Aus dem Resultat wurde ein Summenscore abgeleitet. Ergebnisse: Bei 67, 65, 9 und 38 Patienten wurde die Enddiagnose Pankreaskarzinom (Prävalenz 39 %), chronische Pankreatitis (38 %), neuroendokriner Tumor (5 %) bzw. keine Pankreasekrankung (22 %) gestellt. Die Multivarianzanalyse ergab sechs signifikant mit der Enddiagnose Pankreaskarzinom korrelierte endosonografische Kriterien. Aus ihnen ließ sich zusammen mit dem Patientenalter folgender Summenscore generieren (ja = 1, nein = 0): (dilatierter D. Wirsungianus) + (Gefäßinfiltration) + (suspekte Lymphknoten) + (Tumorrand mit Pseudopodien ähnelnden Ausläufern) + (Alter > 50 Jahre) - (vermehrte Echogenität des Pankreasparenchyms) - (Tumordurchmesser < 10 mm) + 3. In der Receiver-operating-characteristic-Analyse betrug der Area-under-the-curve-Wert des Scores bez. Karzinom 0,85; für Werte > 5 (4) ergaben sich: Sensitivität 0,63 (0,93), Spezifität 0,91 (0,55), positiver prädiktiver Wert 0,82 (0,57), negativer prädiktiver Wert 0,79 (0,92), positive Likelihood Ratio 7,24 (2,05), negative Likelihood Ratio 0,41 (0,14). Schlussfolgerung: Basierend auf sechs endosonografischen Kriterien und Patientenalter wurde ein einfacher Summenscore zur Abschätzung der Karzinomwahrscheinlichkeit bei endosonografisch festgestellter Pankreasraumforderung etabliert. Das untersuchte Patientengut spricht für seine Anwendbarkeit im klinischen Alltag eines tertiären Referenzzentrums. Der Score sollte prospektiv validiert werden.

Abstract

Background: The sensitivity of endosonography for pancreatic tumors is good, but differentiation between malignant and benign lesions remains a challenge. We, therefore, analyzed the correlation between endosonographic findings and pancreatic carcinoma in a population with a high prevalence of chronic pancreatitis. Methods: 171 endosonographic examinations were retrospectively evaluated using 22 dichotomous criteria. Final diagnosis was defined by the results of pancreas resection or by clinical follow-up (median: 41 months). A sum score was established after multivariate analysis. Results: Final diagnosis was carcinoma, chronic pancreatitis, neuroendocrine tumor and normal pancreas in 67, 65, 9, and 38 subjects (prevalence 39 %, 38 %, 5 %, 22 % respectively) After multivariate analysis, carcinoma was significantly correlated with six endosonographic criteria and age, which resulted in the following score (yes = 1, no = 0): (dilated pancreatic duct) + (vascular infiltration) + (suspicious lymph nodes) + (tumor edge with pseudopodia-like extensions) + (age > 50 years) - (increased pancreas parenchyma echogenicity) - (tumor diameter < 10 mm) + 3. After receiver operating characteristic analysis, the area under the curve was 0.85. For score values of 5 (4) or more, sensitivity was 0.63 (0.93), specificity 0.91 (0.55), positive predictive value 0.82 (0.57), negative predictive value 0.79 (0.92), positive likelihood ratio 7.24 (2.05), and negative likelihood ratio 0.41 (0.14). Conclusion: A simple and potentially useful score for the prediction of pancreatic cancer based on six endosonographic criteria and patient age was established. Distribution of final diagnoses in the patient population argues for the score’s applicability in clinical practice of a tertiary referral center and warrants prospective validation.

Endosonografie - Pankreaskarzinom - chronische Pankreatitis - Score

endosonography - pancreatic carcinoma - chronic pancreatitis - score

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