Vascular invasion is an important criterion for resectability and deciding the therapeutic strategy for pancreatic ductal adenocarcinoma (PDAC), but imaging diagnosis is currently difficult. Endoscopic ultrasound (EUS) elastography (EG) images have band-like artifacts on the border between tumor and vessel due to different movement if the tumor is not connected to the vessel, i.e., no invasion. Based on this phenomenon, we assessed the usefulness of EUS-EG in the diagnosis of vascular invasion in PDAC. The subjects were 44 out of 313 patients with PDAC who underwent EUS between January 2015 and November 2018, followed by surgery, no chemotherapy or radiotherapy, and pathological evaluation. Diagnostic accuracies of vascular invasion using dynamic computed tomography (CT), EUS B-mode and EUS-EG were compared with histopathological diagnosis. In 44 subjects (48 sites) who underwent both dynamic CT and EUS-B mode, the sensitivity, specificity and accuracy were 0.733, 0.697 and 0.708 on dynamic CT (48 sites); 0.733, 0.606 and 0.646 in EUS B-mode (48 sites); and 0.917, 0.900 and 0.906 in EUS-EG (32 sites). In 27 subjects (29 sites) with a tumor contacting a vessel with no vascular obstruction or stenosis on dynamic CT, the sensitivity, specificity and accuracy were 0.556, 0.750 and 0.690 on dynamic CT; 0.667, 0.700 and 0.690 in EUS B-mode; and 0.889, 0.850 and 0.862 in EUS-EG. These results suggest that EUS combined with EG improves diagnostic performance of vascular invasion in PDAC, especially in cases of which vascular invasion cannot be clearly assessed by dynamic CT.

中文翻译：

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超声内镜弹性成像诊断胰腺导管腺癌血管侵犯


血管侵犯是胰腺导管腺癌（PDAC）可切除性和决定治疗策略的重要标准，但目前影像诊断较困难。如果肿瘤不与血管相连，即没有侵犯，则内窥镜超声（EUS）弹性成像（EG）图像会因不同的运动而在肿瘤和血管之间的边界处出现带状伪影。基于这一现象，我们评估了 EUS-EG 在诊断 PDAC 血管侵犯中的有用性。研究对象为 2015 年 1 月至 2018 年 11 月期间接受 EUS 的 313 例 PDAC 患者中的 44 例，随后进行手术，未进行化疗或放疗，并进行病理评估。将动态计算机断层扫描 (CT)、EUS B 型和 EUS-EG 的血管侵犯诊断准确性与组织病理学诊断进行比较。在同时接受动态 CT 和 EUS-B 模式的 44 名受试者（48 个部位）中，动态 CT（48 个部位）的敏感性、特异性和准确性分别为 0.733、0.697 和 0.708； EUS B 模式下为 0.733、0.606 和 0.646（48 个站点）； EUS-EG 中为 0.917、0.900 和 0.906（32 个位点）。在 27 名受试者（29 个部位）中，动态 CT 上肿瘤接触血管且无血管阻塞或狭窄，动态 CT 的敏感性、特异性和准确性分别为 0.556、0.750 和 0.690； EUS B 模式下为 0.667、0.700 和 0.690； EUS-EG 中为 0.889、0.850 和 0.862。这些结果表明EUS联合EG提高了PDAC血管侵犯的诊断性能，特别是在动态CT无法清楚评估血管侵犯的情况下。