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

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.

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

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

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