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造影增强超声内镜与增强CT对胰腺实性占位诊断价值的比较分析
DOI: 10.3969/j.issn.1001-5256.2021.07.033
利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明：李静负责课题设计，资料分析，撰写论文；李鑫、张辉参与收集数据；徐有青负责拟定写作思路，指导撰写文章并最后定稿。
Value of contrast-enhanced endoscopic ultrasound versus contrast-enhanced computed tomography in the diagnosis of pancreatic solid space-occupying lesions
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摘要:
目的 探讨造影增强超声内镜(CE-EUS)与增强CT(CE-CT)对胰腺实性占位的诊断价值。 方法 选取2014年1月—2019年12月就诊于首都医科大学附属北京天坛医院的胰腺实性占位患者78例，所有患者均经EUS引导下细针抽吸活检或手术后病理确诊，比较CE-EUS、CE-CT诊断胰腺实性占位的准确率、敏感度、特异度、Youden指数。 结果 CE-EUS、CE-CT诊断胰腺癌的正确率分别为97.9%、87.2%，敏感度分别为97.7%、88.9%，特异度分别为100%、50%，Youden指数分别为0.96、0.76；CE-EUS、CE-CT诊断小胰癌的准确率分别为84.6%、61.5%，敏感度分别为80%、70%，特异度分别为100%、33.3%，Youden指数分别为0.80、0.03；CE-EUS、CE-CT诊断慢性胰腺炎肿块的准确率分别为90.5%、61.9%，敏感度分别为94.1%、64.7%，特异度分别为75%、50%，Youden指数分别为0.69、0.15；CE-EUS、CE-CT诊断胰腺神经内分泌肿瘤的准确率分别为85.7%、28.6%，敏感度分别为83.3%、16.7%，特异度分别为100%、100%，Youden指数分别为0.83、0.17。 结论 在对胰腺实性占位的诊断方面，CE-EUS较CE-CT有明显优势。 -
关键词:
- 胰腺肿瘤 /
- 内分泌腺肿瘤 /
- 腔内超声检查 /
- 体层摄影术，X线计算机 /
- 诊断
Abstract:Objective To investigate the value of contrast-enhanced endoscopic ultrasound (CE-EUS) versus contrast-enhanced computed tomography (CE-CT) in the diagnosis of pancreatic solid space-occupying lesions. Methods A total of 78 patients with pancreatic solid space-occupying lesions who attended Beijing Tiantan Hospital, Capital Medical University, from January 2014 to December 2019 were enrolled. All patients were diagnosed by EUS-guided fine needle aspiration or postoperative pathology, and CE-EUS and CE-CT were compared in terms of their accuracy, sensitivity, specificity, and Youden index in the diagnosis of pancreatic solid space-occupying lesions. Results In the diagnosis of pancreatic cancer, CE-EUS and CE-CT had accuracy rates of 97.9% and 87.2%, sensitivities of 97.7% and 88.9%, specificities of 100% and 50%, and Youden indices of 0.96 and 0.76, respectively. In the diagnosis of small pancreatic cancer, CE-EUS and CE-CT had accuracy rates of 84.6% and 61.5%, sensitivities of 80% and 70%, specificities of 100% and 33.3%, and Youden indices of 0.80 and 0.03, respectively. In the diagnosis of chronic pancreatitis with mass, CE-EUS and CE-CT had accuracy rates of 90.5% and 61.9%, sensitivities of 94.1% and 64.7%, specificities of 75% and 50%, and Youden indices of 0.69 and 0.15, respectively. In the diagnosis of pancreatic neuroendocrine tumors, CE-EUS and CE-CT had accuracy rates of 85.7% and 28.6%, sensitivities of 83.3% and 16.7%, specificities of 100% and 100%, and Youden indices of 0.83 and 0.17, respectively. Conclusion CE-EUS has certain advantages over CE-CT in the diagnosis of pancreatic solid space-occupying lesions. -
表 1 CE-EUS与CE-CT诊断胰腺癌准确率比较
组别 病理学检查(例) 合计(例) 准确率(%) 敏感度(%) 特异度(%) Youden指数 阳性 阴性 CE-EUS 97.9 97.7 100.0 0.96 阳性 44 0 44 阴性 1 2 3 CE-CT 87.2 88.9 50.0 0.76 阳性 40 1 41 阴性 5 1 6 
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表 2 CE-EUS与CE-CT诊断小胰癌准确率比较
组别 病理学检查(例) 合计(例) 准确率(%) 敏感度(%) 特异度(%) Youden指数 阳性 阴性 CE-EUS 84.6 80.0 100.0 0.80 阳性 8 0 8 阴性 2 3 5 CE-CT 61.5 70.0 33.3 0.03 阳性 7 2 9 阴性 3 1 4
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表 3 CE-EUS与CE-CT诊断慢性胰腺炎肿块准确率比较
组别 病理学检查(例) 合计(例) 准确率(%) 敏感度(%) 特异度(%) Youden指数 阳性 阴性 CE-EUS 90.5 94.1 75.0 0.69 阳性 16 1 17 阴性 1 3 4 CE-CT 61.9 64.7 50.0 0.15 阳性 11 2 13 阴性 6 2 8
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表 4 CE-EUS与CE-CT诊断胰腺神经内分泌肿瘤诊断准确率比较
组别 金标准(例) 合计(例) 准确率(%) 敏感度(%) 特异度(%) Youden指数 阳性 阴性 CE-EUS 85.7 83.3 100.0 0.83 阳性 5 0 5 阴性 1 1 2 CE-CT 28.6 16.7 100.0 0.17 阳性 1 0 1 阴性 5 1 6
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