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RSS859例胰腺占位性病变超声造影诊断的准确性分析
Accuracy of Contrast-Enhanced Ultrasound Diagnostic Reports for 859 Cases of Pancreatic Space-occupying Lesions
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摘要:目的 分析胰腺占位性病变超声造影诊断报告的准确性。方法 回顾性收集2017年1月—2022年12月北京协和医院行胰腺占位超声造影检查且最终病理诊断明确的患者病历资料。以病理诊断为金标准, 分析胰腺病变超声造影诊断的准确性, 并具体分析各种病理类型胰腺占位性病变的超声造影误诊情况。结果 共859例符合纳入和排除标准的患者入选本研究, 其中男性489例(56.9%), 女性370例(43.1%); 年龄16~85岁, 中位年龄60(53, 66)岁。除难以应用良恶性进行分类的胰腺占位47例外, 余812例纳入良恶性诊断准确性分析, 结果显示, 超声造影对胰腺恶性病变的诊断灵敏度为98.3%(95% CI: 97.1%~99.1%), 特异度为79.0%(95% CI: 70.1%~86.4%), AUC为0.887(95% CI: 0.863~0.908), 阳性预测值为96.9%(95% CI: 95.6%~97.9%), 阴性预测值为87.4%(95% CI: 79.6%~92.4%), 阳性似然比为4.69(95% CI: 3.24~6.80), 阴性似然比为0.02(95% CI: 0.01~0.04), 超声造影检查诊断胰腺病变良恶性的诊断报告符合率为95.8%。859例胰腺占位病例中, 超声造影误诊48例, 误诊率为5.6%(48/859), 其中包含未定性诊断病例7例(0.8%), 而胰腺导管腺癌的诊断准确率高达98.8%。所有患者超声造影过程中均未发生不良反应事件。结论 超声造影检查安全、有效, 是评估各种胰腺病变微血管灌注的准确成像方法, 对胰腺病变良恶性诊断, 特别是胰腺导管腺癌的定性诊断具有良好的临床应用价值。Abstract:Objective To evaluate the accuracy of contrast-enhanced ultrasound diagnostic reports for pancreatic lesions.Methods In this retrospective study, we included patients who underwent contrast-enhanced ultrasound examination of pancreatic lesions at Peking Union Medical College Hospital from January 2017 to December 2022 and received a confirmed pathological diagnosis. Using pathological diagnosis as the gold standard, the study evaluated the accuracy of contrast-enhanced diagnostic ultrasound. It also analyzed the misdiagnosis of contrast-enhanced ultrasound in diagnosing various pathological types of pancreatic lesions.Results Of the 859 patients who met inclusion and exclusion criteria, 489 were male(56.9%) and 370 were female(43.1%).Their age ranged from 16 to 85 years, with a median age of 60(53, 66) years. Except for 47 pancreatic space-occupying lesions that were difficult to categorize as either benign or malignant, a total of 812 cases were included in the diagnostic efficacy analysis of benign and malignant lesions. The results suggested that the diagnostic sensitivity and specificity of contrast-enhanced ultrasound for pancreatic malignant lesions were 98.3%(95% CI: 97.1%-99.1%) and 79.0%(95% CI: 70.1%-86.4%), AUC was 0.887(95% CI: 0.863-0.908), positive and negative predictive value were 96.9%(95% CI: 95.6%-97.9%) and 87.4%(95% CI: 79.6%-92.4%), positive and negative likelihood ratio were 4.69(95% CI: 3.24-6.80) and 0.02(95% CI: 0.01-0.04). The diagnostic accuracy rate of contrast-enhanced ultrasound for diagnosing benign and malignant pancreatic lesions was 95.8%. Of the 859 lesions examined, 48 cases were misdiagnosed by contrast-enhanced ultrasound, with a misdiagnosis rate of 5.6%(48/859), including 7 cases(0.8%) of undetermined diagnosis, while the diagnostic accuracy of pancreatic ductal adenocarcinoma was as high as 98.8%. No complications occurred in any of the patients.Conclusions Contrast-enhanced ultrasound is a safe and effective imaging method for evaluating microvascular perfusion in various pancreatic lesions. It has significant clinical value in diagnosing both benign and malignant pancreatic lesions, particularly in diagnosing pancreatic ductal adenocarcinoma.
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