Endoscopic ultrasonography can diagnose distal biliary strictures without a mass on computed tomography  

作　　者：Yasuyuki Saifuku Michiko Yamagata Takero Koike Genyo Hitomi Kazunari Kanke Hidetaka Watanabe Toshimitsu Murohisa Masaya Tamano Makoto Iijima Keiichi Kubota Hideyuki Hiraishi 

机构地区：[1]Department of Gastroenterology,Dokkyo Medical University,880 Kitakobayashi,Mibu,Shimotsuga-gun,Tochigi 321-0293,Japan [2]Second Department of Surgery,Dokkyo Medical University,Tochigi 321-0293,Japan

出　　处：《World Journal of Gastroenterology》2010年第2期237-244,共8页世界胃肠病学杂志（英文版）

摘　　要：AIM:To assess the diagnostic ability of endoscopic ultrasonography(EUS)for evaluating causes of dista biliary strictures shown on endoscopic retrograde chol angiopancreatography(ERCP)or magnetic resonance cholangiopancreatography(MRCP),even without iden tifiable mass on computed tomography(CT). METHODS:The diagnostic ability of EUS was retro spectively analyzed and compared with that of routine cytology(RC)and tumor markers in 34 patients with distal biliary strictures detected by ERCP or MRCP a Dokkyo Medical School Hospital from December 2005 to December 2008,without any adjacent mass or ec centric thickening of the bile duct on CT that could cause biliary strictures.Findings considered as benign strictures on EUS included preservation of the normasonographic layers of the bile duct wall,irrespective of the presence of a mass lesion.Other strictures were considered malignant.Final diagnosis of underlying diseases was made by pathological examination in 18 cases after surgical removal of the samples,and by clinical follow-up for>10 mo in 16 cases. RESULTS:Seventeen patients(50%)were finally di- agnosed with benign conditions,including 6"normal" subjects,while 17 patients(50%)were diagnosed with malignant disease.In terms of diagnostic ability,EUS showed 94.1%sensitivity,82.3%specificity,84.2% positive predictive value,93.3%negative predictive value(NPV)and 88.2%accuracy for identifying ma- lignant and benign strictures.EUS was more sensi- tive than RC(94.1%vs 62.5%,P=0.039).NPV was also better for EUS than for RC(93.3%vs 57.5%,P= 0.035).In addition,EUS provided significantly higher sensitivity than tumor markers using 100 U/mL as the cutoff level of carbohydrate antigen 19-9(94.1%vs 53%,P=0.017).On EUS,biliary stricture that was fi- nally diagnosed as malignant showed as a hypoechoic, irregular mass,with obstruction of the biliary duct and invasion to surrounding tissues. CONCLUSION:EUS can diagnose biliary strictures caused by malignant tumors that are undetectable on CT.Earlier detection by EUS would provide mAIM:To assess the diagnostic ability of endoscopic ultrasonography(EUS)for evaluating causes of dista biliary strictures shown on endoscopic retrograde chol angiopancreatography(ERCP)or magnetic resonance cholangiopancreatography(MRCP),even without iden tifiable mass on computed tomography(CT). METHODS:The diagnostic ability of EUS was retro spectively analyzed and compared with that of routine cytology(RC)and tumor markers in 34 patients with distal biliary strictures detected by ERCP or MRCP a Dokkyo Medi...

关 键 词：Computed tomography CYTOLOGY Endoscopic retrograde cholangiopancreatography Endoscopic ultrasound Indeterminate biliary stricture Magnetic resonance cholangiopancreatography Tumor marker 

分 类 号：R445.1[医药卫生—影像医学与核医学]