| Background and objectives:Pancreatic cancer is a highly malignant gastrointestinal tumor and the 5-year survival rate is only 10%.It has become an important factor threatening human health.Due to their atypical clinical symptoms,about 80%of patients have advanced stage at the time of treatment and can only receive conservative treatment such as chemotherapy.However,the high drug resistance and low drug response rate of pancreatic cancer severely limit the effect of chemotherapy drugs.Studies have shown that stromal fibrosis is an important pathological feature of pancreatic cancer,and the increase of stromal proportion is also one of the main causes of chemotherapy resistance.Therefore,more and more stroma-targeting therapies have become the focus of clinical trials,hoping to improve the chemotherapy response rate and effective rate of patients with a high proportion of tumor stroma through stroma clearance.Therefore,the evaluation of tumor stromal components becomes an important part of the diagnosis and treatment process.two-dimensional shear-wave elastography(2D-SWE)is a new technology that can quantitatively evaluate tissue elasticity(hardness).It is safe,painless and reproducible.Therefore,by exploring the correlation between elasticity values measured by 2D-SWE and tumor stromal components,we expect to provide a noninvasive evaluation method for individualized treatment guidance and efficacy monitoring of pancreatic cancer.On the other hand,in patients with resectable pancreatic cancer,the incidence and risk of postoperative pancreatic fistula are extremely high and dangerous,which may lead to severe abscesses,bleeding and even life-threatening.Therefore,early risk factor prediction and active and effective intervention become an important part of perioperative management.Current studies have confirmed that the hardness of residual normal pancreatic tissue after tumor resection is closely related to the occurrence of postoperative pancreatic fistula.The higher the hardness,the more resistant the tearing force of the suture,and the lower the incidence of pancreatic fistula.Therefore,we further assumed that 2D-SWE could quantitatively assess the hardness of residual normal pancreatic tissue before surgery,analyze its relationship with postoperative pancreatic fistula,clarify the value of 2D-SWE in predicting postoperative pancreatic fistula,provide timely and effective prediction information for clinical practice,and develop individualized perioperative management strategies for high-risk patients so that they can get more timely and effective clinical treatment.Methods:The basic information and clinical data of patients who were admitted to the Department of Hepatobiliary Surgery of our hospital from July 2021 to November 2022for resection of pancreatic space occupying lesions were prospectively collected.Preoperative ultrasound examination was performed to collect relevant ultrasonic parameters,and intraoperative and postoperative follow-up investigations were conducted.Pathological staining analysis was performed on tumor resection specimens of patients,and relevant pathological characteristics data were collected.Correlation study was used to analyze the correlation between various parameters,and the diagnostic value of2D-SWE was determined by ROC curve.Results:1.The success rate of 2D-SWE in detecting pancreatic mass was 89.9%(62/69),and the intra-observer intra-class correlation coefficient(ICC)was 0.832.A total of 52 patients with pancreatic ductal adenocarcinoma were subsequently included in the first part of the study,and there was a significant positive correlation between tumor elasticity value and stromal proportion(r_s=0.646),and a significant negative correlation between tumor cell number(r_s=-0.585).The elasticity measured by 2D-SWE,the surgeon’s palpation hardness and the ratio of tumor stroma had good correlation.2D-SWE could accurately distinguish between mild and severe interstitial fibrosis,and its diagnostic efficacy was better than palpation assessment,but the difference was not statistically significant(P=0.103).2.A total of 55 patients with pancreatic space occupying lesions were included in the second part of the study,and the incidence of postoperative pancreatic fistula(POPF)was47.3%(26/55).The incidence of clinically relevant postoperative pancreatic fistula(CR-POPF)was 23.6%(13/55).They were grouped according to the presence or absence of POPF and CR-POPF.After univariate and multivariate analysis,it was concluded that male was independent risk factors for CR-POPF,and increased elasticity was independent protective factor for CR-POPF.ROC curve combined with area under curve analysis showed that 2D-SWE had good diagnostic value in predicting CR-POPF(area under curve was 0.819,P<0.001).Conclusions:1.The elasticity value obtained by 2D-SWE is closely related to the proportion of pancreatic cancer stroma and the number of tumor cells,which can be used to accurately assess the degree of interstitial fibrosis.Therefore,2D-SWE can be used as a non-invasive imaging biomarker to guide the personalized treatment of pancreatic cancer,and play an important role in monitoring the therapeutic effect.2.The preoperative quantitative assessment of the stiffness of residual normal pancreatic tissue in patients undergoing pancreatic resection by 2D-SWE clarified that low residual pancreatic elasticity value is an independent risk factor for clinically relevant postoperative pancreatic fistula,and verified its high value in predicting postoperative pancreatic fistula,which can guide clinicians to formulate individualized perioperative management strategies for high-risk patients at an early stage and get more timely and effective clinical management. |
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