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Sonoelastrografi ile fokal pankreas kitleleri; fokal pankreatit mi? Pankreatik adonakanser mi?

Yıl 2018, Cilt: 17 Sayı: 3, 104 - 109, 29.12.2018
https://doi.org/10.17941/agd.473867

Öz

Giriş ve Amaç: Ultrasonografi
pankreas kitlelerinde kullanışlı bir yöntem olmakla birlikte özellikle kuyruk
lokalizasyonundaki lezyonların görüntülenmesinde sınırlılıkları vardır ve fokal
pankreatik lezyonların benign-malign ayırıcı tanısına katkısı sınırlıdır. Bunun
yanı sıra çok kesitli bilgisayarlı tomografi ve manyetik rezonans görüntüleme yöntemleri
ile de zaman zaman pankreas kanseri-fokal pankreatit ayırıcı tanısında bazı
güçlükler yaşanmakta ve bazen biyopsiye ihtiyaç duyulmaktadır.

Bu çalışmada kesitsel
görüntüleme yöntemleri ile fokal pankreatit-pankreas kanseri açısıdan optimal
ayırıcı tanı yapılamayan hastalarda transabdominal ultrasonografi ve eş zamanlı
sonoelastografi tetkiki yapılarak sonoelastografinin ayırıcı tanıya katkısı
araştırıldı.

Gereç ve Yöntem: Bu çalışmada 2013-2017 tarihleri
arasında hastanemizde histopatolojik olarak 52 pankreas kanseri ve 14 fokal
pankreatit tanısı alan hastanın sonoelastografi bulguları karşılaştırıldı.

Bulgular: Pankreatik
adenokanser hastalarının yaş ortalaması istatistiksel anlamlı olarak fokal
pankreatit hastalarından yüksekti. Yine adenokanser hastalarında ortalama serum
alfa-fetoprotein seviyesi fokal pankreatit hastalarına oranla anlamlı olarak
yüksekti. Fakat lezyonların çaplarında ve sonoelastografide elde edilen gerinim
indeksi değerlerinde her iki grup arasında istatistiksel olarak anlamlı fark
saptanmadı. Ayrıca adenokanser ve fokal pankreatit arasında renkle kodlanma tipleri
açısından anlamlı fark elde edilmedi.









Sonuç: Sonoelastografi, mükemmel duyarlılıkla görüntülenen
benign ve malign kitleler arasındaki karekterizasyon ve farklılaşmayı
artırabilecek ümit verici bir tekniktir. Fakat bu aşamada pankreatik
adenokanser ile fokal pankreatit arasındaki fark açısından henüz sonoelastografinin
özgüllüğü düşüktür. 

Kaynakça

  • 1. Park MK, Jo J, Kwon H, et al. Usefulness of acoustic radiation force impulse elastography in the differential diagnosis of benign and malignant solid pancreatic lesions. Ultrasonography 2014;33:26-33.
  • 2. Ophir J, Garra B, Kallel F, et al. Elastographic imaging. Ultrasound Med Biol 2000;26(Suppl. 1):S23-9.
  • 3. Bojunga J, Herrmann E, Meyer G, et al. Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 2010;20:1145-50.
  • 4. Ooi CC, Malliaras P, Schneider ME, Connell DA. ‘‘Soft, hard, or just right?’’ Applications and limitations of axial-strain sonoelastography and shear-wave elastography in the assessment of tendon injuries. Skeletal Radiol 2014;43:1-12.
  • 5. Menzilcioglu MS, Duymus M, Gungor G, et al. The value of real-time ultrasound elastography in chronic autoimmune thyroiditis. Br J Radiol 2014;87:20140604.
  • 6. Muller M, Gennisson JL, Deffieux T, et al. Quantitative viscoelasticity mapping of human liver using supersonic shear imaging: preliminary in vivo feasibility study. Ultrasound Med Biol 2009;35:219-29.
  • 7. Arda K, Ciledag N, Aribas BK, et al. Quantitative assessment of the elasticity values of liver with shear wave ultrasonographic elastography. Indian J Med Res 2013;137:911-5.
  • 8. Uchida H, Hirooka Y, Itoh A, et al. Feasibility of tissue elastography using transcutaneous ultrasonography for the diagnosis of pancreatic diseases. Pancreas 2009; 38: 17-22.
  • 9. Ito T, Ishiguro H, Ohara H, et al. Evidence-based clinical practice guidelines for chronic pancreatitis 2015. J Gastroenterol 2016;51:85-92
  • 10. Shimosegawa T, Kataoka K, Kamisawa T, et al. The revised Japanese clinical diagnostic criteria for chronic pancreatitis. J Gastroenterol 2010;45:584-91.
  • 11. Bedi MM, Gandhi MD, Jacob G, et al. CA 19-9 to differentiate benign and malignant masses in chronic pancreatitis: is there any benefit? Indian J Gastroenterol 2009;28:24-7.
  • 12. Psarras K, Baltatzis ME, Pavlidis ET, et al. Autoimmune pancreatitis versus pancreatic cancer: a comprehensive review with emphasis on differential diagnosis. Hepatobiliary Pancreat Dis Int 2011;10:465-73. Review.
  • 13. Díte P, Uvírová M, Bojková M,et al. Differentiating autoimmune pancreatitis from pancreatic cancer. Minerva Gastroenterol Dietol 2014;60:247-53. Epub 2014 Oct 7. Review.
  • 14. Manikkavasakar S, AlObaidy M, Busireddy KK, et al. Magnetic resonance imaging of pancreatitis: An update. World J Gastroenterol 2014;20:14760-77.
  • 15. McMahon CJ. The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound in diagnosis of common bile duct calculi: a critically appraised topic Abdominal imaging 2008;33:6-9.
  • 16. Takahashi N, Fletcher JG, Fidler JL, et al. Dual-phase CT of autoimmune pancreatitis: a multireader study. AJR Am J Roentgenol 2008;190:280-6.
  • 17. Mariappan YK, Glaser KJ, Ehman RL. Magnetic resonance elastography: a review. Clin Anat 2010;23:497-511.
  • 18. Rebours V, Le Baleur Y, Cazals-Hatem D, et al. Immunoglobulin G4 immunostaining of gastric, duodenal, or colonic biopsies is not helpful for the diagnosis of autoimmune pancreatitis. Clin Gastroenterol Hepatol 2012;10:91-4.
  • 19. Kim MH, Moon SH, Kamisawa T. Major duodenal papilla in autoimmune pancreatitis. Dig Surg 2010;27:110-4.
  • 20. Korc M. Pancreatic cancer associated stroma production. Am J Surg 2007;194(4 Suppl):s84-s86..
  • 21. Park MK, Jo J, Kwon H, et al. Usefulness of acoustic radiation force impulse elastography in the differential diagnosis of benign and malignant solid pancreatic lesions. Ultrasonography 2014;33:26-33.
  • 22. Onur MR, Goya C. Ultrasound elastography: abdominal applications. Turkiye Klinikleri J Radiol Special Topics 2013;6:59-69.
  • 23. Cosgrove D, Piscaglia F, Bamber J, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: clinical applications. Ultraschall Med 2013;34:238-53.
  • 24. Kawada N, Tanaka S. Elastography for the pancreas: Current status and future perspective. World J Gastroenterol 2016;22:3712-24.
  • 25. Fahey BJ, Nelson RC, Bradway DP, et al. In vivo visualization of abdominal malignancies with acoustic radiation force elastography. Phys Med Biol 2008;53:279-93.
  • 26. Yu H, Wilson SR. Differentiation of benign from malignant liver masses with acoustic radiation force impulse technique. Ultrasound Q 2011;27:217-23.
  • 27. Nightingale KR, Palmeri ML, Nightingale RW, Trahey GE. On the feasibility of remote palpation using acoustic radiation force. J Acoust Soc Am 2001;110:625-34.
  • 28. Friedrich-Rust M, Wunder K, Kriener S, et al. Liver fibrosis in viral hepatitis: non invasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology 2009;252:595-604.
  • 29. Adrian Sãftoiu, Peter Vilman. Endoscopic Ultrasound Elastography – a New Imaging Technique for the Visualization of Tissue Elasticity Distribution. J Gastrointestin Liver Dis June 2006;15:161-5.
  • 30. Janssen J, Schlörer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions. Gastrointest Endosc 2007;65:971-8.
  • 31. Hirche TO, Ignee A, Barreiros AP, et al. Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions. Endoscopy 2008;40:910-7.
  • 32. Iglesias-Garcia J, Larino-Noia J, Abdulkader I, et al. EUS elastography for the characterization of solid pancreatic masses. Gastrointest Endosc 2009;70:1101-8.
  • 33. Uchida H, Hirooka Y, Itoh A, et al. Feasibility of tissue elastography using transcutaneous ultrasonography for the diagnosis of pancreatic diseases. Pancreas 2009;38:17-22.
  • 34. Giovannini M, Thomas B, Erwan B, et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. World J Gastroenterol 2009;15:1587-93.
  • 35. Kawada N, Tanaka S, Uehara H, et al. Feasibility of second-generation transabdominal ultrasound-elastography to evaluate solid pancreatic tumors: preliminary report of 36 cases. Pancreas 2012;41:978-80.
  • 36. Janssen J, Schlorer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions. Gastrointest Endosc 2007;65:971-8.
  • 37. Kloppel G, Detlefsen S, Feyerabend B. Fibrosis of the pancreas: the initial tissue damage and the resulting pattern. Virchows Arch 2004;445:1-8.
  • 38. Iordache S, Costache MI, Popescu CF, et al. Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUSguided FNA. Med Ultrason 2016;18:18-24.

Pancreatic mass with sonoelastography, fokal pancreatitis or pancreatic adeno ca?

Yıl 2018, Cilt: 17 Sayı: 3, 104 - 109, 29.12.2018
https://doi.org/10.17941/agd.473867

Öz

Background and Aims:
Ultrasonography is a useful method in pancreatic masses, especially in the
localization of lesions in the tail, and the contribution to the
benign-malignant differential diagnosis of focal pancreatic lesions is limited.
In addition, multislice computed tomography and magnetic resonance imaging
methods are used to detect pancreatic cancer-focal pancreatitis some
difficulties are experienced in the differential diagnosis and sometimes biopsy
is needed.

In this study, transabdominal ultrasonography and
simultaneous sonoelastography were performed in patients who could not undergo
an optimal differential diagnosis for focal pancreatitis or pancreatic adeno ca,
and the contribution of sonoelastography to differential diagnosis was
investigated.

Materials and Methods:
In this study, sonoelastography findings of 52 pancreatic ca and 14 focal
pancreatitis patients were compared histopathologically in our hospital between
2013-2017.

Results: The mean
age of pancreatic adeno-ca patients was statistically higher than focal
pancreatitis patients. The mean level of serum alfafetoprotein was
significantly higher in patients with adeno ca than in patients with focal
pancreatitis. However, there was no statistically significant difference
between the two groups in the diameter of the lesions and strain index values
obtained in the sonoelastography. Furthermore, no significant difference was
found between adenocarcinoma and focal pancreatitis in terms of color coding
types.

Conclusion: Sonoelastography is a promising technique to
improve the characterization and differentiation between benign and malignant
masses displayed with excellent sensitivity. However, at this stage, the
specificity of sonoelastography is still low in terms of the difference between
pancreatic adenocarcinoma and focal pancreatitis.


Kaynakça

  • 1. Park MK, Jo J, Kwon H, et al. Usefulness of acoustic radiation force impulse elastography in the differential diagnosis of benign and malignant solid pancreatic lesions. Ultrasonography 2014;33:26-33.
  • 2. Ophir J, Garra B, Kallel F, et al. Elastographic imaging. Ultrasound Med Biol 2000;26(Suppl. 1):S23-9.
  • 3. Bojunga J, Herrmann E, Meyer G, et al. Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 2010;20:1145-50.
  • 4. Ooi CC, Malliaras P, Schneider ME, Connell DA. ‘‘Soft, hard, or just right?’’ Applications and limitations of axial-strain sonoelastography and shear-wave elastography in the assessment of tendon injuries. Skeletal Radiol 2014;43:1-12.
  • 5. Menzilcioglu MS, Duymus M, Gungor G, et al. The value of real-time ultrasound elastography in chronic autoimmune thyroiditis. Br J Radiol 2014;87:20140604.
  • 6. Muller M, Gennisson JL, Deffieux T, et al. Quantitative viscoelasticity mapping of human liver using supersonic shear imaging: preliminary in vivo feasibility study. Ultrasound Med Biol 2009;35:219-29.
  • 7. Arda K, Ciledag N, Aribas BK, et al. Quantitative assessment of the elasticity values of liver with shear wave ultrasonographic elastography. Indian J Med Res 2013;137:911-5.
  • 8. Uchida H, Hirooka Y, Itoh A, et al. Feasibility of tissue elastography using transcutaneous ultrasonography for the diagnosis of pancreatic diseases. Pancreas 2009; 38: 17-22.
  • 9. Ito T, Ishiguro H, Ohara H, et al. Evidence-based clinical practice guidelines for chronic pancreatitis 2015. J Gastroenterol 2016;51:85-92
  • 10. Shimosegawa T, Kataoka K, Kamisawa T, et al. The revised Japanese clinical diagnostic criteria for chronic pancreatitis. J Gastroenterol 2010;45:584-91.
  • 11. Bedi MM, Gandhi MD, Jacob G, et al. CA 19-9 to differentiate benign and malignant masses in chronic pancreatitis: is there any benefit? Indian J Gastroenterol 2009;28:24-7.
  • 12. Psarras K, Baltatzis ME, Pavlidis ET, et al. Autoimmune pancreatitis versus pancreatic cancer: a comprehensive review with emphasis on differential diagnosis. Hepatobiliary Pancreat Dis Int 2011;10:465-73. Review.
  • 13. Díte P, Uvírová M, Bojková M,et al. Differentiating autoimmune pancreatitis from pancreatic cancer. Minerva Gastroenterol Dietol 2014;60:247-53. Epub 2014 Oct 7. Review.
  • 14. Manikkavasakar S, AlObaidy M, Busireddy KK, et al. Magnetic resonance imaging of pancreatitis: An update. World J Gastroenterol 2014;20:14760-77.
  • 15. McMahon CJ. The relative roles of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound in diagnosis of common bile duct calculi: a critically appraised topic Abdominal imaging 2008;33:6-9.
  • 16. Takahashi N, Fletcher JG, Fidler JL, et al. Dual-phase CT of autoimmune pancreatitis: a multireader study. AJR Am J Roentgenol 2008;190:280-6.
  • 17. Mariappan YK, Glaser KJ, Ehman RL. Magnetic resonance elastography: a review. Clin Anat 2010;23:497-511.
  • 18. Rebours V, Le Baleur Y, Cazals-Hatem D, et al. Immunoglobulin G4 immunostaining of gastric, duodenal, or colonic biopsies is not helpful for the diagnosis of autoimmune pancreatitis. Clin Gastroenterol Hepatol 2012;10:91-4.
  • 19. Kim MH, Moon SH, Kamisawa T. Major duodenal papilla in autoimmune pancreatitis. Dig Surg 2010;27:110-4.
  • 20. Korc M. Pancreatic cancer associated stroma production. Am J Surg 2007;194(4 Suppl):s84-s86..
  • 21. Park MK, Jo J, Kwon H, et al. Usefulness of acoustic radiation force impulse elastography in the differential diagnosis of benign and malignant solid pancreatic lesions. Ultrasonography 2014;33:26-33.
  • 22. Onur MR, Goya C. Ultrasound elastography: abdominal applications. Turkiye Klinikleri J Radiol Special Topics 2013;6:59-69.
  • 23. Cosgrove D, Piscaglia F, Bamber J, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: clinical applications. Ultraschall Med 2013;34:238-53.
  • 24. Kawada N, Tanaka S. Elastography for the pancreas: Current status and future perspective. World J Gastroenterol 2016;22:3712-24.
  • 25. Fahey BJ, Nelson RC, Bradway DP, et al. In vivo visualization of abdominal malignancies with acoustic radiation force elastography. Phys Med Biol 2008;53:279-93.
  • 26. Yu H, Wilson SR. Differentiation of benign from malignant liver masses with acoustic radiation force impulse technique. Ultrasound Q 2011;27:217-23.
  • 27. Nightingale KR, Palmeri ML, Nightingale RW, Trahey GE. On the feasibility of remote palpation using acoustic radiation force. J Acoust Soc Am 2001;110:625-34.
  • 28. Friedrich-Rust M, Wunder K, Kriener S, et al. Liver fibrosis in viral hepatitis: non invasive assessment with acoustic radiation force impulse imaging versus transient elastography. Radiology 2009;252:595-604.
  • 29. Adrian Sãftoiu, Peter Vilman. Endoscopic Ultrasound Elastography – a New Imaging Technique for the Visualization of Tissue Elasticity Distribution. J Gastrointestin Liver Dis June 2006;15:161-5.
  • 30. Janssen J, Schlörer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions. Gastrointest Endosc 2007;65:971-8.
  • 31. Hirche TO, Ignee A, Barreiros AP, et al. Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions. Endoscopy 2008;40:910-7.
  • 32. Iglesias-Garcia J, Larino-Noia J, Abdulkader I, et al. EUS elastography for the characterization of solid pancreatic masses. Gastrointest Endosc 2009;70:1101-8.
  • 33. Uchida H, Hirooka Y, Itoh A, et al. Feasibility of tissue elastography using transcutaneous ultrasonography for the diagnosis of pancreatic diseases. Pancreas 2009;38:17-22.
  • 34. Giovannini M, Thomas B, Erwan B, et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. World J Gastroenterol 2009;15:1587-93.
  • 35. Kawada N, Tanaka S, Uehara H, et al. Feasibility of second-generation transabdominal ultrasound-elastography to evaluate solid pancreatic tumors: preliminary report of 36 cases. Pancreas 2012;41:978-80.
  • 36. Janssen J, Schlorer E, Greiner L. EUS elastography of the pancreas: feasibility and pattern description of the normal pancreas, chronic pancreatitis, and focal pancreatic lesions. Gastrointest Endosc 2007;65:971-8.
  • 37. Kloppel G, Detlefsen S, Feyerabend B. Fibrosis of the pancreas: the initial tissue damage and the resulting pattern. Virchows Arch 2004;445:1-8.
  • 38. Iordache S, Costache MI, Popescu CF, et al. Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUSguided FNA. Med Ultrason 2016;18:18-24.
Toplam 38 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Melike Ruşen Metin

Mustafa Tahtacı Bu kişi benim

Yayımlanma Tarihi 29 Aralık 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 17 Sayı: 3

Kaynak Göster

APA Metin, M. R., & Tahtacı, M. (2018). Sonoelastrografi ile fokal pankreas kitleleri; fokal pankreatit mi? Pankreatik adonakanser mi?. Akademik Gastroenteroloji Dergisi, 17(3), 104-109. https://doi.org/10.17941/agd.473867

test-5