EUS Evaluation Of Periampullary Carcinoma And Its Comparative Study With MRI,MRCP And CT

Objective:To evaluate the diagnostic value of EUS in periampullary carcinoma,and compare it with MRI,MRCP,CT and other imaging diagnostic methods,analyze the advantages and disadvantages of different imaging diagnostic methods,and provide reference for the diagnosis and differential diagnosis of periampullary cancer.Methods:73 patients who were admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from February 2017 to May 2018 and whose pathological diagnosis was periampullary cancer were collected.Based on the results of pathological diagnosis,retrospective study of EUS,MRI,MRCP and CT in the diagnosis of periampullary cancer,the specificity,sensitivity,analysis of EUS,CT,MRI and MRCP imaging of periampullary cancer imaging Signs,comparing the diagnostic performance of different imaging methods.Results:A total of 73 cases were included in the study,including 51 males(69.86%)and 22 females(30.14%).The patients were 78 years old and the youngest was 29 years old,with an average of 62.03±9.12 years old.All patients underwent puncture or surgical pathological examination.The pathological diagnosis results were periampullary carcinoma,including 23 cases of ampullary carcinoma(31.50%),22 cases of duodenal papillary carcinoma(30.14%),and 14 cases of pancreatic head cancer.(19.18%),14 cases of lower common bile duct cancer(19.18%).The coincidence rate of EUS in the diagnosis of periampullary carcinoma was 78.08%,which was higher than CT(66.18%),MRI(62.5%),and MRCP(55.71%).There was no significant difference between EUS and CT in the overall diagnosis rate of periampullary carcinoma(P>0.05).The overall diagnosis rate of EUS was higher than that of MRI and MRCP.The difference was statistically significant.(P<0.05).Comparing the diagnostic coincidence rates of EUS,MRI and MRCP in different types of periampullary carcinoma,it was found that the diagnostic coincidence rate of EUS duodenal papillary carcinoma was significantly different from MRI and MRCP(P=0.043).The diagnostic coincidence rate of the lower common bile duct cancer was different from that of MRCP,and the difference was statistically significant(P=0.007).The results of ROC curve showed that EUS,CT,MRI and MRCP were superior to other three types of periampullary carcinoma in the diagnosis of pancreatic head cancer.EUS and CT had similar diagnostic efficacy for pancreatic head cancer,and both were superior to MRI and MRCP.EUS is superior to the other three diagnostic methods in the diagnosis of ampullary carcinoma,duodenal papillary carcinoma and lower common bile duct cancer.The sensitivity of EUS to different types of periampullary carcinoma was 71.43%?86.96%,and the specificity was 88.68%-100%.The sensitivity of MRI to different types of periampullary carcinoma was 54.55%?71.43%,and the specificity was 80.70%.?100%;MRCP sensitivity to different types of periampullary cancer is 41.67%?61.54%,specificity is 75.81%?100%;CT sensitivity to different types of periampullary cancer is 47.62%?84.62%,specific The sex is 87.93%?96.49%.ROC curves were drawn based on the specificity and sensitivity of different diagnostic methods.The results show that EUS diagnostic efficacy is superior to the other three diagnostic methods.EUS analyzed the blood supply,morphology,margin,convex luminal,echo,pancreaticobiliary dilatation ratio,and luminal morphology of the obstruction site in different types of periampullary carcinoma.The blood supply insufficiency rate(100%),morphological irregularity rate(100%),mass convex lumen rate(100%),and blood supply insufficiency rate(100%)of pancreatic head cancer were higher than ampullary carcinoma.(56.5%,43.5%,56.5%),duodenal cancer(36.4%,22.7%,36.4%),lower common bile duct cancer(35.7%,21.4%,35.7%),the difference was statistically significant(P<0.05).The margin clearance rate of ampullary carcinoma(56.5%)was higher than that of lower common bile duct cancer(71.4%)and pancreatic head cancer(86.7%),and the difference was statistically significant(P<0.05).Echocardial cancer echo(low echo rate 100%)and ampullary cancer echo(low echo rate 13%,equal echo rate 30.4%,high echo 56.5%),duodenal papillary cancer echo(low echo rate 13.6%),echo rate 31.8%,high echo 54.5%),lower common bile duct cancer echo(low echo rate 71.4%,equal echo rate 0%,high echo 28.6%),the difference was statistically significant(P<0.05 The echo of the lower quadrant of the common bile duct was different from that of the ampullary carcinoma and duodenal papillary carcinoma,and the difference was statistically significant(P<0.05).There was a difference between the duodenal papillary carcinoma and the ampullary cancer echo,but the difference was not statistically significant(P>0.05).The pancreaticobiliary dilatation ratio of pancreatic head cancer was higher than that of ampullary carcinoma,duodenal papillary carcinoma,and lower common bile duct cancer,and the difference was statistically significant(ampullary carcinoma,P<0.0001;duodenal papillary carcinoma,P<0.0001;lower common bile duct cancer,P=0.001).The luminal morphology of the obstruction site of ampullary carcinoma(truncated type,30.4%;56.5%of the beak type,13.0%of the tail type)and duodenal papillary carcinoma(truncated type,68.2%;0%of the beak type,rat tail Type 31,8%),lower common bile duct cancer(truncated type,57.1%;beak type 14.3%,rat tail type 28.60%),different pancreatic head cancer(truncated type,64.3%;bird's beak type 14.3%,rat tail type 21.4%),the difference was statistically significant(P<0.05).There was a significant difference between ampullary carcinoma and duodenal papillary carcinoma(x2=117.496,P=0.001);Conclusion:EUS diagnosed the coincidence rate of periampullary cancer,higher than CT,MRI,MRCP.EUS,CT,MRI,and MRCP are superior to other three types of periampullary carcinoma in the diagnosis of pancreatic head cancer.EUS and CT have similar diagnostic efficacy for pancreatic head cancer,and are superior to MRI and MRCP.EUS for ampullary carcinoma,duodenal papillary carcinoma and below bravery manager cancer diagnosis efficiency is better than the other three imaging methods.During the EUS examination,the blood supply,shape,edge,convexity to the lumen,echo,pancreaticobiliary dilatation ratio,and luminal morphology of the obstruction can be used as reference for the classification of periampullary cancer.