| Objective:Retrospective analysis of clinical data from patients with pancreatic neuroendocrine tumors by immunohistochemical pathology,to Compare the differences between preoperative imaging and intraoperative rapid pathological findings and immunohistochemical pathology,so as to explore the guiding value of preoperative imaging and intraoperative rapid pathology in the diagnosis and treatment of pancreatic neuroendocrine tumors.Methods:About 81 cases were collected from the First Affiliated Hospital of Xinjiang Medical University and the People’s Hospital of Xinjiang Uygur Autonomous Region from May 01,2007 to October 31,2018,and were treated with surgical treatment and postoperative immunohistochemical pathology to confirm the clinical manifestations of pancreatic neuroendocrine tumors.And the diagnosis of pancreatic neuroendocrine tumor diagnosis was analyzed by preoperative imaging and intraoperative rapid pathological examination.Results:1.Among the 81 patients,the most commonly used imaging methods before surgery were US and CT,which were 63(33.7%)and 78(41.7%),respectively,followed by MRI,29(15.5%),e-US.Less,for 17 cases(9.1%).2.There were 11 cases of single examination,including 9 cases of CT and 2 cases of MRI.A total of69 patients(53%)underwent joint examination,of which US combined with CT examination was the most common,31 cases;US,e-US,CT,MRI had correct diagnosis rates of pNETs of 3.2%,41.2%,24.4%,and 37.9%,respectively.There were statistical differences between US and the latter,and e-US,CT,and MRI were compared with each other,and there was no statistical difference.In the wrong diagnosis,US is significantly better than e-US,MRI,CT,and there are statistical differences.There was no statistical difference between the latter three,but the misdiagnosis of CT was significantly higher than MRI.US missed diagnosis of 56 cases(88.9%),misdiagnosis in 5 cases,e-US missed diagnosis in 4cases(23.5%),the remaining 4 cases were misdiagnosed as solid pseudopapillary tumor ofthe pancreas,CT missed diagnosis of 24 cases(30.8%),misdiagnosis of 35 cases(44.9%),MRI missed 10 cases(34.5%)and misdiagnosed 8 cases.2.Intraoperative rapid pathology was correctly diagnosed in 47 cases(68.1%),missed diagnosis in 12 cases(17.4%),missed diagnosis of fibrocystic tissue in 2 cases,frozen section without abnormalities in 4 cases,chronic inflammation in 3 cases,rapid examination showed pancreas Organized in 3 cases.Misdiagnosis of 10 cases(14.5%),misdiagnosis of the disease showed 3 cases of solid pseudopapillary tumor of the pancreas,the other 7 cases were all shown as adenocarcinoma.3.Preoperative imaging,intraoperative rapid pathology,and preoperative imaging combined with intraoperative rapid pathology for correct diagnosis of pancreatic neuroendocrine tumors were 20.9%,68.1%,and77.9%,respectively.The rate of missed diagnosis was 50.3%,17.4%,and7.4%,respectively,and the misdiagnosis rate was 28.9%,14.5%,and 14.7%.4.At the same time,a total of 68 cases of preoperative imaging and intraoperative rapid pathology were improved,including 25 cases(36.8%)diagnosed by radiography and 46 cases(67.6%)confirmed by rapid pathology.There were statistical differences between them(McNemar test,P< 0.01).Conclusion:The diagnosis of pNETs,whether it is imaging examination or rapid intraoperative pathological examination,shows a lower rate of diagnosis than other pancreatic tumors,and has a high rate of missed diagnosis.The misdiagnosis is mainly diagnosed as pancreatic cancer,followed by pancreatic cancer.It is a solid pseudopapillary tumor of the pancreas.US has a worse diagnosis rate than pancreatic organ contrast echoography,abdominal enhanced CT and enhanced nuclear magnetic resonance,but the rate of misdiagnosis is lower.Although the comparison between CT and MRI is not satisfactory,it is still an irreplaceable inspection method.This study found that the diagnosis of intraoperative rapid pathology was still superior to preoperative imaging. |
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