内镜超声在鉴别无功能性胰腺神经内分泌肿瘤与胰腺内副脾中的作用-动脉网

Usefulness of endoscopic ultrasonography for differentiating between non-functional pancreatic neuroendocrine neoplasm and intrapancreatic accessory spleen

Nature 等信源发布 2025-02-21 04:00

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可切换为仅中文

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Abstract

摘要

In pancreatic hypervascular masses, it is often difficult to differentiate pancreatic neuroendocrine neoplasm (PanNEN) and intrapancreatic accessory spleen (IPAS) before surgery because of their similar features, such as a round shape and early enhancement. This study aimed to examine the efficacy of endoscopic ultrasonography (EUS) for differentiating between them.

在胰腺高血管肿块中，由于胰腺神经内分泌肿瘤（PanNEN）和胰腺内副脾（IPAS）具有相似的特征，如圆形和早期增强，术前往往难以区分它们。本研究旨在探讨内镜超声（EUS）在鉴别它们之间的有效性。

This retrospective pilot study enrolled 136 patients with pathologically confirmed non-functional PanNEN or IPAS who underwent EUS at our institution. The clinical features, conventional EUS findings, EUS elastography (EUS-EG) findings, and contrast-enhanced harmonic EUS (CH-EUS) findings were retrospectively evaluated.

这项回顾性试点研究纳入了136名在本机构接受EUS检查的病理确诊非功能性PanNEN或IPAS患者。回顾性评估了临床特征、常规EUS表现、EUS弹性成像（EUS-EG）表现和增强谐波EUS（CH-EUS）表现。

In conventional EUS, calcification had significant differences between PanNEN and IPAS (.

在传统EUS中，胰腺神经内分泌肿瘤（PanNEN）和胰腺浆液性囊腺瘤（IPAS）之间的钙化存在显著差异。

= 0.006). On EUS-EG findings (stiff/soft), patients with PanNEN had softer lesions (6 (25%)/18 (75%)) and those with IPAS had stiffer lesions (3 (100%)/0 (0%)) (

= 0.006)。在EUS-EG检查结果（硬/软）中，PanNEN患者的病灶较软（6（25%）/18（75%）），而IPAS患者的病灶较硬（3（100%）/0（0%））（

= 0.029). CH-EUS revealed that 4/4 (100%) patients with IPAS had hyperechoic or isoechoic vascular patterns up to 300 s, while only 1/15 (7%) patient with PanNEN had such patterns at 300 s (

= 0.029)。CH-EUS 显示，4/4（100%）的 IPAS 患者在 300 秒内呈现高回声或等回声的血管模式，而仅 1/15（7%）的 PanNEN 患者在 300 秒时呈现这种模式 (

= 0.001), resulting in significant washout after 180 s in PanNEN group. This study is the first report on EUS to differentiate between PanNEN and IPAS. It is useful to evaluate calcification with conventional EUS, stiffness with EUS-EG, and enhancement patterns with CH-EUS for that.

= 0.001），在PanNEN组中导致180秒后显著的冲洗效果。本研究是首个关于使用EUS区分PanNEN和IPAS的报告。通过常规EUS评估钙化、通过EUS-EG评估硬度，以及通过CH-EUS评估增强模式对此非常有用。

Introduction

简介

Among pancreatic hypervascular masses, pancreatic neuroendocrine neoplasm (PanNEN), intrapancreatic accessory spleen (IPAS), and pancreatic metastasis of hypervascular tumor can be differentiated. The differentiation between PanNEN and IPAS is particularly important when there is no preexisting or coexisting hypervascular tumor, such as renal carcinoma, outside the pancreas.

在胰腺高血管性肿块中，可以鉴别胰腺神经内分泌肿瘤（PanNEN）、胰腺内副脾（IPAS）和高血管性肿瘤的胰腺转移。当胰腺外不存在或未同时存在肾细胞癌等高血管性肿瘤时，PanNEN与IPAS之间的鉴别尤为重要。

PanNEN basically requires surgery, whereas IPAS does not; therefore, they should be accurately differentiated before surgery. However, since both lesions have similar features with round shape and early enhancement, there are many reports on surgery for IPAS patients with a preoperative diagnosis of PanNEN which was unnecessary as a result.

胰腺神经内分泌肿瘤基本需要手术治疗，而自身免疫性胰腺炎则不需要，因此应在术前准确区分两者。然而，由于这两种病灶具有相似的特征，如圆形和早期增强，有很多关于自身免疫性胰腺炎患者被误诊为胰腺神经内分泌肿瘤而进行不必要手术的报告。

，

. Hence, there is a need to accurately differentiate these lesions before surgery by novel methods.

因此，有必要通过新颖的方法在手术前准确区分这些病灶。

Transabdominal ultrasonography (TUS) is widely used for pancreatic diseases in clinical practice because of a noninvasive method. However, TUS is often difficult to visualize the lesions due to gastrointestinal gas and visceral fat, and in particular, the diseases located in pancreatic tail is difficult to be visualized anatomically.

经腹部超声（TUS）因其无创性在临床实践中被广泛用于胰腺疾病的诊断。然而，由于胃肠道气体和内脏脂肪的影响，TUS常常难以清晰显示病灶，特别是位于胰尾的病变在解剖学上更难以可视化。

. On the other hand, endoscopic ultrasonography (EUS) has higher resolution than TUS and is a relatively new method which can observe the pancreas at close range from within the digestive tract, making it possible to clearly observe lesions even in the pancreatic tail. Therefore, EUS may be suitable for patients with PanNEN or IPAS which are difficult to differentiate in the pancreatic tail.

另一方面，内镜超声（EUS）比经腹超声（TUS）分辨率更高，是一种相对较新的方法，可以从消化道内部近距离观察胰腺，即使在胰尾部位也能清晰观察病变。因此，EUS可能适用于胰尾部难以鉴别的PanNEN或IPAS患者。

However, there have been no reports using EUS to differentiate between PanNEN and IPAS, and this study was conducted to evaluate its usefulness..

然而，目前尚无使用EUS来区分PanNEN和IPAS的报道，本研究旨在评估其有用性。

Methods

方法

Study design

研究设计

A single-center retrospective study was conducted at Nagoya University Hospital after approval by the Ethics Review Committee (date registered: December 8, 2015; Approval Number: 2015-0316) and was performed in accordance with the Declaration of Helsinki. In addition, an opt-out format was posted on the hospital website, giving patients the opportunity to refuse to participate in this study..

在名古屋大学医院进行了一项单中心回顾性研究，该研究已获得伦理审查委员会的批准（注册日期：2015年12月8日；批准编号：2015-0316），并按照《赫尔辛基宣言》进行。此外，医院网站上发布了选择退出格式，让患者有机会拒绝参与本研究。

Patients

患者

The patients with pathologically confirmed PanNEN or IPAS for whom EUS was performed at Nagoya University Hospital between August 2006 and December 2022 were included in this study. However, since functional PanNEN is not difficult to distinguish from IPAS in clinical practice, PanNEN was limited to non-functional PanNEN.

本研究纳入了2006年8月至2022年12月期间在名古屋大学医院接受EUS检查且病理确诊为PanNEN或IPAS的患者。然而，由于功能性PanNEN在临床实践中不难与IPAS区分，因此PanNEN仅限于非功能性PanNEN。

In addition, because IPAS basically occurs in the pancreatic tail, only PanNEN located in the pancreatic tail was included to avoid bias due to lesion localization. In patients with multiple lesions, only the largest lesion was evaluated. The lesion diameter was determined via surgical specimens from operative patients and on the basis of EUS images for nonoperative patients.

此外，由于IPAS基本发生在胰尾部，为避免因病灶位置引起的偏倚，仅纳入位于胰尾的PanNEN。对于多发病灶的患者，仅评估最大的病灶。病灶直径通过手术患者的手术标本以及非手术患者的EUS图像确定。

PanNEN pathology classification was based on the World Health Organization (WHO) classification.

PanNEN病理分类基于世界卫生组织（WHO）分类。

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Conventional EUS

传统EUS

EUS was performed by experts with more than 10 years of experience or by a trainee under an expert’s supervision. Patients’ vital signs were monitored in the left lateral position under sedation with midazolam. Various ultrasound endoscopes and ultrasound observation devices were used, and the types were selected at the discretion of the expert.

EUS由具有10年以上经验的专家或在专家监督下的学员进行。患者在使用咪达唑仑镇静的情况下，左侧卧位监测生命体征。使用了各种超声内镜和超声观察设备，类型由专家自行决定。

EUS images were stored as still images. On the basis of the diagnostic criteria of the Japanese Society of Ultrasound Medicine.

EUS图像以静态图像的形式存储。基于日本超声医学学会的诊断标准。

, conventional EUS findings were assessed for the following predetermined tumor features: contour (clear and regular/clear and irregular/unclear), interior (hyper/iso/hypoechoic), lateral shadow, anechoic areas, and calcification echoes. Color or power Doppler images were classified as type A (peritumoral vessels with or without intratumoral vessels [A2 or A1]), type B (only intratumoral vessels), or type C (flow was absent) on the basis of the previously published classification of vascular structures.

常规EUS检查评估了以下预定的肿瘤特征：轮廓（清晰且规则/清晰但不规则/不清晰）、内部（高回声/等回声/低回声）、侧方声影、无回声区和钙化回声。彩色或能量多普勒图像根据先前发布的血管结构分类，分为A型（肿瘤周围血管伴或不伴肿瘤内血管[A2或A1]）、B型（仅有肿瘤内血管）或C型（无血流）。

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Endoscopic ultrasonography elastography (EUS-EG)

内镜超声弹性成像 (EUS-EG)

After conventional EUS, strain elastography was performed via real-time tissue elastography (Hitachi, Tokyo, Japan), ELST (Olympus, Tokyo, Japan), or elastography (Fujifilm, Tokyo, Japan) systems. The region of interest (ROI) was set to include the entire lesion with sufficient peripancreatic parenchyma to ensure that the lesion accounted for less than 50% of the total ROI.

常规EUS后，通过实时组织弹性成像（Hitachi，东京，日本）、ELST（Olympus，东京，日本）或弹性成像（Fujifilm，东京，日本）系统进行应变弹性成像。感兴趣区域（ROI）设定为包括整个病灶及足够的胰周实质，以确保病灶占总ROI的不到50%。

Strain elastography was used to estimate relative tissue stiffness on the basis of strain generated by the pulse wave in the aorta. For the relative stiffness of the stiff, average, and soft tissues, the tissues were visualized as blue, green, and red, respectively. Since the EUS-EG color map can change instantly, a video lasting for a few seconds was recorded, and still images of the lesion were extracted from the video.

应变弹性成像通过主动脉中的脉冲波生成的应变来评估组织的相对硬度。对于硬、中等和软组织的相对硬度，分别将组织显示为蓝色、绿色和红色。由于EUS-EG颜色图可以瞬间变化，因此录制了一段持续几秒钟的视频，并从视频中提取了病灶的静态图像。

This procedure was repeated several times if necessary. With reference to our previous study.

如有必要，此程序会重复多次。参考我们之前的研究。

, each EUS-EG image was classified as blue-dominant, equivalent, or green-dominant on the basis of the blue‒green ratio of the lesion. Using many EUS-EG images from the same patients, lesions with more blue-dominant images than green-dominant images were classified as stiff, whereas all other lesions were classified as soft.

，每张EUS-EG图像根据病灶的蓝绿比被分类为蓝色主导、均衡或绿色主导。利用来自相同患者的多张EUS-EG图像，蓝色主导图像多于绿色主导图像的病灶被归类为僵硬，而所有其他病灶被归类为柔软。

Since this was a retrospective study, there were some cases in which EUS-EG was not performed..

由于这是一项回顾性研究，有些病例未进行EUS-EG。

Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS)

对比增强谐波内镜超声（CH-EUS）

For CH-EUS, one vial of Sonazoid (16 µL as perflubutane) (GE Healthcare Japan, Tokyo, Japan) was suspended in 2 ml of water for injection, and the suspension was administered by bolus injection at 0.015 ml/kg. After Sonazoid administration, CH-EUS images were continuously recorded as videos for 60 s, and images were also recorded at 180 s and 300 s.

对于CH-EUS，将一瓶Sonazoid（16 µL的全氟丁烷）（GE Healthcare Japan，东京，日本）悬浮于2毫升注射用水中，并以0.015毫升/千克的剂量进行快速注射。在注入Sonazoid后，连续录制CH-EUS图像视频60秒，并在180秒和300秒时记录图像。

The stored data were used for analysis. The images recorded at 20, 40, 60, 180 and 300 s were used for evaluation. On the basis of our previous study.

存储的数据被用于分析。记录的20、40、60、180和300秒的图像被用于评估。根据我们之前的研究。

, vascular patterns were classified as hyperechoic, isoechoic, or hypoechoic compared with the surrounding pancreatic parenchyma. Since this was a retrospective study, some patients did not have images stored at each CH-EUS time phase.

，血管模式被分为高回声、等回声或低回声，与周围胰腺实质相比。由于这是一项回顾性研究，一些患者在每个CH-EUS时间阶段没有存储图像。

Final diagnosis

最终诊断

The diagnosis of PanNEN was made based on surgical specimens from operative patients and on endoscopic ultrasound-guided tissue acquisition (EUS-TA) samples from nonoperative patients, and all patients were diagnosed pathologically. On the other hand, the diagnosis of IPAS was pathologically made based on surgical specimens in all cases..

根据手术患者的手术标本和非手术患者的内镜超声引导下组织获取（EUS-TA）样本，对PanNEN进行了诊断，并且所有患者均经病理诊断。另一方面，IPAS的诊断在所有病例中均基于手术标本进行病理诊断。

Data analysis

数据分析

EUS images were independently reviewed by three readers (YK, TIs, and KY) who were blinded to the patients’ backgrounds, clinical information, radiographic findings, and pathological findings. Still images were used for evaluation. Interobserver variability in EUS findings was assessed by measuring the kappa coefficient after each of the three readers performed their individual assessments.

EUS图像由三位阅片者（YK、TIs和KY）独立审查，他们对患者背景、临床信息、影像学发现和病理学发现均不知情。评估使用静态图像。通过在三位阅片者各自完成评估后测量kappa系数来评估EUS结果的观察者间差异。

Agreement was defined as minor (kappa coefficient 0.01–0.20), fair (0.21–0.40), moderate (0.41–0.60), good (0.61–0.80), or excellent (0.81–1.00). When the judgment of each finding differed between readers, the final decision was determined by majority vote..

一致性被定义为轻微（kappa系数0.01-0.20）、一般（0.21-0.40）、中等（0.41-0.60）、良好（0.61-0.80）或极佳（0.81-1.00）。当每位读者对每项结果的判断不同时，最终决定由多数投票确定。

Statistical analysis

统计分析

To evaluate differences in patient backgrounds, continuous variables were subjected to Student’s t test if normality was present and the Mann‒Whitney U test if not. All categorical variables were subjected to the chi-square test. For all conventional EUS findings and color or power Doppler imaging (CDI) parameters, the chi-square test was performed.

为了评估患者背景的差异，如果数据符合正态分布，则连续变量采用 Student's t 检验，如果不符合正态分布，则采用 Mann‒Whitney U 检验。所有分类变量均进行卡方检验。对于所有常规 EUS 表现和彩色或能量多普勒成像（CDI）参数，也进行了卡方检验。

For all EUS-EG and CH-EUS parameters, Fisher’s exact test was performed. The significance level was set at 5% in all tests. EZR (version. 1.56) software was used for statistical analysis.

对于所有EUS-EG和CH-EUS参数，进行了Fisher精确检验。所有检验的显著性水平设定为5%。使用EZR（版本1.56）软件进行统计分析。

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Results

结果

A total of 136 patients (128 patients in PanNEN group, 8 patients in IPAS group) were included in this study. Of 128 patients in PanNEN group, 92 patients were excluded because of pancreatic head or body lesion. Finally, 44 patients (36 patients in PanNEN group, 8 patients in IPAS group) were analyzed in this study (Fig. .

本研究共纳入136例患者（PanNEN组128例，IPAS组8例）。在PanNEN组的128例患者中，有92例因胰头或胰体病变被排除。最终，本研究对44例患者（PanNEN组36例，IPAS组8例）进行了分析（图。

). All lesions in this study were clearly visualized via EUS, and there were no adverse events for all patients included in this study. In terms of patient background, all parameters did not show significant differences (Table

）。本研究中的所有病灶均通过EUS清晰可见，且本研究中所有患者均未发生不良事件。在患者背景方面，所有参数均未显示出显著差异（表

). All of the patients in the IPAS group had a preoperative diagnosis of PanNEN based on imaging, and surgery was performed without EUS-TA, considering the risks of postpuncture bleeding or needle tract seeding. For PanNEN grading, 29/36 patients (81%) had G1, 7/36 patients (19%) had G2, and 0/36 patients (0%) had G3.

IPAS组的所有患者均基于影像学检查术前诊断为PanNEN，并考虑到穿刺后出血或针道种植的风险，手术未进行EUS-TA。对于PanNEN分级，29/36患者（81%）为G1，7/36患者（19%）为G2，0/36患者（0%）为G3。

Among the patients with PanNEN, 3/36 (8%) had MEN1..

在PanNEN患者中，3/36（8%）患有MEN1。

Fig. 1

图1

Flow chart of patients recruited in this study.

本研究中招募患者的流程图。

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Table 1 Characteristics of the patients and lesions included in this study.

表1 本研究中纳入的患者和病灶特征。

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In terms of conventional EUS and CDI findings, only calcification echoes had significant differences between PanNEN and IPAS (

在传统的EUS和CDI表现方面，只有钙化回声在PanNEN和IPAS之间存在显著差异（

= 0.006), but all other parameters did not show significant differences (Table

= 0.006)，但所有其他参数均未显示出显著差异（表

). In the EUS-EG stiffness classification (stiff/soft), all patients with IPAS showed stiff lesions (3 (100%)/0 (0%)), and those with PanNEN had softer lesions (6 (25%)/18 (75%)), indicating a significant difference between the two groups (

在EUS-EG硬度分类（硬/软）中，所有IPAS患者均表现为硬性病灶（3（100%）/0（0%）），而PanNEN患者则表现为较软的病灶（6（25%）/18（75%）），表明两组之间存在显著差异（

= 0.029) (Table

= 0.029) （表

). The sensitivity, specificity, and accuracy for differentiating between PanNEN and IPAS via EUS-EG (stiff or soft) were 75%, 100%, and 78%, respectively. In the EUS-EG stiffness classification (stiff/soft) among the PanNEN group, the patients with G1 had softer lesions (2 (11%)/17 (89%)), and those with G2 had stiffer lesions (4 (80%)/1 (20%)), indicating a significant difference between the G1 and G2 groups (.

通过EUS-EG（硬或软）区分PanNEN和IPAS的敏感性、特异性和准确性分别为75%、100%和78%。在PanNEN组的EUS-EG硬度分类（硬/软）中，G1患者的病灶较软（2（11%）/17（89%）），而G2患者的病灶较硬（4（80%）/1（20%）），表明G1和G2组之间存在显著差异（。

= 0.009).

= 0.009)。

Table 2 Comparison of conventional EUS findings and EUS-EG stiffness classification between the PanNEN and IPAS groups.

表2 常规EUS表现与EUS-EG硬度分类在PanNEN组和IPAS组之间的比较。

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In the CH-EUS findings, the hyper + isoechoic/hypoechoic vascular patterns in the PanNEN versus IPAS groups were 25 (96%)/1 (4%) versus 4 (100%)/0 (0%) at 20 s (

在CH-EUS检查结果中，PanNEN组与IPAS组的高回声+等回声/低回声血管模式在20秒时分别为25例（96%）/1例（4%）和4例（100%）/0例（0%）（

= 1.000), 24 (92%)/2 (8%) versus 4 (100%)/0 (0%) at 40 s (

= 1.000), 24 (92%)/2 (8%) 对比 4 (100%)/0 (0%) 在 40 秒 (

= 0.698), 20 (77%)/6 (23%) versus 4 (100%)/0 (0%) at 60 s (

= 0.698)，20（77%）/6（23%）对比4（100%）/0（0%）在60秒时（

= 0.06), 5 (26%)/14 (74%) versus 4 (100%)/0 (0%) (

= 0.06)，5（26%）/14（74%）对比4（100%）/0（0%）（

= 0.006) at 180 s, 1 (7%)/14 (93%) versus 4 (100%)/0 (0%) at 300 s (

= 0.006) 在 180 秒时，1 (7%)/14 (93%) 对比 4 (100%)/0 (0%) 在 300 秒时 (

= 0.001), resulting in significant washout after 180 s in the PanNEN group (Table

= 0.001)，在PanNEN组中180秒后出现显著的冲洗（表

, Fig.

，图。

). The sensitivity, specificity, and accuracy for differentiating between PanNEN and IPAS via CH-EUS (hypoechoic at 300 s) were 93%, 100%, and 95%, respectively. In the CH-EUS findings among the PanNEN group, the hyper + isoechoic/hypoechoic vascular patterns in G1 versus G2 groups were 21 (95%)/1 (5%) versus 4 (100%)/0 (0%) at 20 s (.

通过CH-EUS（300秒时低回声）区分PanNEN和IPAS的敏感性、特异性和准确性分别为93%、100%和95%。在PanNEN组的CH-EUS结果中，G1组与G2组在20秒时的高回声+等回声/低回声血管模式分别为21（95%）/1（5%）和4（100%）/0（0%）。（

= 1.000), 20 (91%)/2 (9%) versus 4 (100%)/0 (0%) at 40 s (

= 1.000), 20 (91%)/2 (9%) 对比 4 (100%)/0 (0%) 在 40 秒 (

= 0.713), 17 (77%)/5 (23%) versus 3 (75%)/1 (25%) at 60 s (

= 0.713)，17 (77%)/5 (23%) 对比 3 (75%)/1 (25%) 在 60 秒时 (

= 1.000), 5 (31%)/11 (69%) versus 0 (0%)/3 (100%) (

= 1.000), 5 (31%)/11 (69%) 对比 0 (0%)/3 (100%) (

= 0.53) at 180 s, 1 (8%)/11 (92%) versus 0 (0%)/3 (100%) at 300 s (

= 0.53) 在 180 秒，1 (8%)/11 (92%) 对比 0 (0%)/3 (100%) 在 300 秒 (

= 1.000), resulting in no significant differences for PanNEN grading at all phases.

= 1.000），导致在所有阶段对PanNEN分级均无显著差异。

Table 3 Comparison of the CH-EUS vascular patterns between the PanNEN and IPAS groups.

表3 PanNEN组和IPAS组之间CH-EUS血管模式的比较。

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Fig. 2

图2

Differences in contrast-enhancement patterns between the IPAS and PanNEN groups. (

IPAS组和PanNEN组之间强化模式的差异。

) In the IPAS group, all lesions presented a hyperechoic or isoechoic vascular pattern up to 300 s and prolonged contrast enhancement. (

在IPAS组中，所有病灶在300秒内均呈现高回声或等回声的血管模式，并伴有长时间的对比增强。

) In the PanNEN group, most lesions showed a hyperechoic or isoechoic vascular pattern up to 40 s, but the number of lesions with a hypoechoic vascular pattern increased from 60 to 300 s, and almost all lesions were washed out at 300 s.

在PanNEN组中，大多数病灶在40秒内表现为高回声或等回声的血管模式，但在60至300秒之间，低回声血管模式的病灶数量增加，几乎所有的病灶在300秒时被清除。

Full size image

全尺寸图像

In conventional EUS, EUS-EG, and CH-EUS, characteristic findings between PanNEN and IPAS groups are shown in Fig.

在传统的EUS、EUS-EG和CH-EUS中，PanNEN和IPAS组之间的特征性发现如图所示。

. The interobserver agreement among the three readers was relatively good, with moderate- excellent for conventional EUS findings (kappa coefficient = 0.589–0.852), excellent for EUS-EG stiffness classification (kappa coefficient = 0.827), and moderate-good for CH-EUS (kappa coefficient = 0.492–0.651)..

三位阅片者之间的观察者间一致性相对较好，传统EUS表现的一致性为中等到极好（kappa系数=0.589-0.852），EUS-EG硬度分类的一致性极好（kappa系数=0.827），CH-EUS的一致性为中等到良好（kappa系数=0.492-0.651）。

Fig. 3

图3

Characteristic findings between PanNEN and IPAS groups in conventional EUS, EUS-EG, and CH-EUS.

传统EUS、EUS-EG和CH-EUS中PanNEN与IPAS组之间的特征性发现。

Full size image

全尺寸图像

Representative EUS images of the PanNEN and IPAS cases are shown in Fig.

图中展示了PanNEN和IPAS病例的代表性EUS图像。

and Fig.

和图。

。

Fig. 4

图4

A case of pancreatic neuroendocrine neoplasm. (

胰腺神经内分泌肿瘤一例。

) Endoscopic ultrasonography (EUS) revealed a 31-mm hypoechoic lesion without calcification echoes. (

）超声内镜（EUS）显示一个31毫米的低回声病变，无钙化回声。（

) The lesion was classified as type A2 by vascular architecture classification. (

）病变被血管结构分类归类为A2型。（

) EUS elastography revealed green-dominant patterns, and the lesion was classified as soft. (

EUS弹性成像显示以绿色为主的模式，病灶被分类为柔软。

) In contrast-enhanced harmonic EUS, the lesion showed a hyperechoic vascular pattern at 20 s, an isoechoic vascular pattern at 40 s and 60 s, and a hypoechoic vascular pattern at 180 s and 300 s.

在增强谐波EUS中，病灶在20秒时表现为高回声血管模式，在40秒和60秒时表现为等回声血管模式，在180秒和300秒时表现为低回声血管模式。

Full size image

全尺寸图像

Fig. 5

图5

A case of intrapancreatic accessory spleen. (

胰腺内副脾一例。

) Endoscopic ultrasonography (EUS) revealed a 13-mm hypoechoic lesion with calcification echoes. (

）超声内镜（EUS）显示一个13毫米的低回声病变，伴有钙化回声。（

) The lesion was classified as type B by vascular architecture classification. (

）病变被血管结构分类归类为B型。（

) EUS elastography revealed blue-dominant patterns, and the lesion was classified as stiff. (

EUS弹性成像显示以蓝色为主的模式，病灶被分类为僵硬。

) In contrast-enhanced harmonic EUS, the lesion showed a hyperechoic vascular pattern at 20 s, 40 s, 60 s, and 180 s and an isoechoic vascular pattern at 300 s.

在增强谐波EUS中，病灶在20秒、40秒、60秒和180秒时呈现高回声血管模式，在300秒时呈现等回声血管模式。

Full size image

全尺寸图像

Discussion

讨论

Among pancreatic hypervascular masses, the differentiation between PanNEN and IPAS is particularly important when there is no preexisting or coexisting hypervascular tumor, such as renal carcinoma, outside the pancreas. PanNEN and IPAS should be accurately differentiated before surgery because of their different surgical necessity, but it is often difficult to judge the indication of surgery because of their similar features, such as a round shape and early enhancement.

在胰腺高血管性肿块中，当胰腺外不存在或未并发其他高血管性肿瘤（如肾细胞癌）时，区分胰腺神经内分泌肿瘤（PanNEN）和局灶性自身免疫性胰腺炎（IPAS）尤为重要。由于两者对手术的需求不同，术前应准确鉴别，但因其特征相似（如圆形和早期强化），往往难以判断手术指征。

There have been no reports of attempts to differentiate between these lesions via EUS, and this study revealed that calcification via conventional EUS, stiffness classification via EUS-EG, and multiphase evaluation via CH-EUS were useful for differentiating between them..

目前尚无通过EUS区分这些病变的尝试报道，本研究发现，通过常规EUS评估钙化、通过EUS-EG评估硬度分类以及通过CH-EUS进行多阶段评估对于区分它们是有用的。

In recent years, the usefulness of EUS-EG for pancreatic solid masses has been reported, with a sensitivity of 92.3% and specificity of 80% for the diagnosis of benign or malignant masses

近年来，EUS-EG 对胰腺实性肿块的有用性已被报道，其诊断良性或恶性肿块的敏感性为 92.3%，特异性为 80%。

. According to the results of EUS-EG in this study, 18/24 (75%) PanNEN were classified as soft, and 3/3 (100%) IPAS were classified as stiff (

根据本研究中EUS-EG的结果，24例PanNEN中有18例（75%）被分类为柔软型，3例IPAS全部（100%）被分类为坚硬型（

= 0.029). Regarding the EUS-EG results for PanNEN, there are reports that 73/114 (64%) lesions were classified as soft lesions

= 0.029)。关于PanNEN的EUS-EG结果，有报告显示73/114（64%）的病灶被归类为软性病灶。

and 10/10 (100%) were classified as stiff lesions

并且10/10（100%）被分类为僵硬病灶

. It has been reported that fibrosis increases with progressing PanNEN grade

据报道，随着PanNEN分级的进展，纤维化程度增加。

, and the PanNEN grade may affect the stiffness of lesions. For the patients with PanNEN in the present study, it is assumed that soft lesions were more common because most of the lesions were low-grade lesions (G1: 29/36 (81%), G2: 7/36 (19%)). On the other hand, IPAS is histologically similar to the spleen, and the stiffness of the spleen is generally high.

，PanNEN的分级可能会影响病灶的硬度。在本研究中，对于PanNEN患者，假设较软的病灶更为常见，因为大多数病灶为低级别病变（G1：29/36（81%），G2：7/36（19%））。另一方面，IPAS在组织学上与脾脏相似，而脾脏的硬度通常较高。

Therefore, there may have been stiffer lesions in patients with IPAS in this study..

因此，在这项研究中，IPAS患者的病灶可能更为僵硬。

On the other hand, there have also been several reports on the usefulness of CH-EUS for pancreatic solid masses

另一方面，也有几篇关于CH-EUS在胰腺实性肿块中的有用性的报告。

，

, and a meta-analysis of the diagnostic performance of CH-EUS for pancreatic cancer reported a sensitivity of 93–94% and specificity of 88–89%

，一项关于CH-EUS在胰腺癌诊断性能的荟萃分析报告称，其敏感性为93%-94%，特异性为88%-89%。

，

. The results of CH-EUS in the present study revealed that 4/4 (100%) IPAS had hyperechoic or isoechoic vascular patterns up to 300 s, while only 1/15 (7%) PanNEN had such patterns at 300 s (

本研究中的CH-EUS结果显示，4/4（100%）的IPAS在300秒内呈现高回声或等回声的血管模式，而只有1/15（7%）的PanNEN在300秒时呈现这种模式（

= 0.001). PanNEN is generally considered to be hyperechoic vascular pattern on CH-EUS, but most reports have evaluated this lesion up to 60 s

= 0.001)。PanNEN在CH-EUS上通常被认为具有高回声血管模式，但大多数报告评估该病变的时间最长为60秒。

，

. In this study, PanNEN showed a decrease in contrast enhancement over time, from 60 to 300 s. It is considered that the contrast enhancement is prolonged in the liver and spleen because Sonazoid is trapped by intraretinal components such as Kupffer cells. Therefore, contrast enhancement is considered to have been prolonged up to 300 s in patients with IPAS, which contain tissue similar to spleen tissue, whereas contrast enhancement is considered to have been significantly washed out after 180 s in patients with PanNEN, in which no intraretinal components are present.

在这项研究中，PanNEN 的对比增强随着时间的推移而减少，从 60 秒到 300 秒。由于 Sonazoid 被肝内视网膜成分（如 Kupffer 细胞）捕获，因此在肝脏和脾脏中对比增强时间延长。因此，在包含类似脾脏组织的 IPAS 患者中，对比增强被认为可以延长至 300 秒，而在没有肝内视网膜成分的 PanNEN 患者中，对比增强在 180 秒后显著清除。

On the other hand, in pancreatic hypervascular masses, although rare, solid serous cystic neoplasms (SCNs) can be also differentiated. Solid SCNs often present with enhancement of the entire mass by contrast-enhanced computed tomography and may be difficult to distinguish from PanNEN or IPAS. However, since CH-EUS reveals multiple microcysts within the mass in solid SCNs, it is also useful to differentiate solid SCNs from PanNEN and IPAS..

另一方面，在胰腺富血管肿块中，虽然较为罕见，但实性浆液性囊性肿瘤（SCNs）也可以进行鉴别。实性SCNs在增强计算机断层扫描中通常表现为整个肿块的强化，可能难以与PanNEN或IPAS区分。然而，由于对比增强超声内镜（CH-EUS）能够揭示实性SCNs肿块内的多个微囊，因此也有助于将实性SCNs与PanNEN和IPAS区分开来。

In recent years, the usefulness of superparamagnetic iron oxide-magnetic resonance imaging (SPIO-MRI) for the diagnosis of IPAS has been reported

近年来，超顺磁性氧化铁-磁共振成像（SPIO-MRI）在IPAS诊断中的有用性已被报道。

, but there are no reports of its usefulness in differentiating IPAS from PanNEN. Furthermore, in this study, SPIO-MRI was performed in seven patients with IPAS who underwent surgery, and only three (43%) of the seven patients were diagnosed with IPAS via SPIO-MRI and the remaining four (57%) patients were difficult to diagnose due to motion artifacts or small lesions, and the accuracy rate was not sufficient.

，但尚无关于其在IPAS与PanNEN鉴别诊断中的有用性的报告。此外，在本研究中，对7名接受手术的IPAS患者进行了SPIO-MRI检查，其中仅3名（43%）患者通过SPIO-MRI诊断为IPAS，其余4名（57%）患者由于运动伪影或病灶较小而难以诊断，准确率并不足够。

Furthermore, all of the three patients diagnosed with IPAS via SPIO-MRI underwent surgery due to suspicion of PanNEN on the basis of other imaging studies. On the other hand, somatostatin receptor scintigraphy, such as .

此外，所有三例通过SPIO-MRI诊断为IPAS的患者均因其他影像学检查怀疑胰腺神经内分泌肿瘤（PanNEN）而接受了手术。另一方面，生长抑素受体显像，如。

111

In-octreoscan, has been used to diagnose PanNEN. However,

In-octreoscan已被用于诊断PanNEN。然而，

111

In-octreoscan has been reported to have a sensitivity of 52%, specificity of 93%, and accuracy of 58%

据报道，In-octreoscan的敏感性为52%，特异性为93%，准确率为58%。

, and its diagnostic performance is not sufficient. Therefore, these imaging tests are considered to have only a supplementary position for differentiating between IPAS and PanNEN.

，其诊断性能并不充分。因此，这些影像学检查被认为在鉴别IPAS和PanNEN时仅具有辅助地位。

The usefulness of EUS-TA for the histopathological diagnosis of pancreatic masses has been reported in many articles, but it has a risk of bleeding for patients with hypervascular masses. In a previous study at our institution, the accuracy rate of EUS-TA for PanNEN was less than 70%, which was unsatisfactory.

许多文章报道了EUS-TA在胰腺肿块的组织病理学诊断中的有用性，但对于血供丰富的肿块患者存在出血风险。在我们机构之前的一项研究中，EUS-TA对PanNEN的准确率不到70%，令人不满意。

. On the other hand, with respect to EUS-TA for IPAS, there has been a report that the proof of CD8-positive sinusoidal endothelial cells was useful for the diagnosis of IPAS

另一方面，关于IPAS的EUS-TA，有报告显示CD8阳性的窦状内皮细胞的证据对IPAS的诊断有用。

, but a few reports on EUS-TA for IPAS are all case reports, and the diagnostic performance of EUS-TA remains unclear. In the present study, EUS-TA was performed in only a few patients. This may be because this study included patients with lesions that were difficult to puncture because of the localization of the pancreatic tail end and near the splenic artery or vein, and there were concerns about needle tract seeding.

，但关于EUS-TA用于IPAS的少数报道均为病例报告，EUS-TA的诊断性能仍不明确。在本研究中，仅对少数患者进行了EUS-TA。这可能是因为本研究纳入了由于胰尾端位置及靠近脾动脉或静脉而难以穿刺的病变患者，并且存在针道种植的担忧。

，

and postpuncture bleeding because of the hypervascular nature of the lesions. In fact, there have been reports of a high incidence of bleeding after EUS-TA in patients with PanNEN

由于病灶血管丰富，术后出血的风险增加。事实上，有报道称在胰腺神经内分泌肿瘤（PanNEN）患者中，EUS-TA后出血的发生率较高。

. Therefore, EUS-TA does not always provide a pathological diagnosis. From these perspectives, our facility adopts a policy of not to force EUS-TA on lesions diagnosed as pancreatic tumors based on imaging findings, where surgical intervention is deemed appropriate. In the present study, all IPAS cases were preoperatively diagnosed as PanNEN, and surgery was performed without EUS-TA.

因此，EUS-TA并不总是能提供病理诊断。基于这些观点，我们机构采取了一项政策，即对于根据影像学检查结果诊断为胰腺肿瘤且认为手术干预合适的病灶，不强制进行EUS-TA。在本研究中，所有IPAS病例术前均被诊断为PanNEN，并在未进行EUS-TA的情况下进行了手术。

However, based on the results of this study, EUS-TA may be considered in the future for cases where IPAS is a potential differential diagnosis. To differentiate between PanNEN and IPAS, this study revealed that it is useful to evaluate calcification via conventional EUS, stiffness via EUS-EG, and enhancement patterns via CH-EUS, without pathological specimen collection.

然而，基于本研究的结果，对于IPAS作为潜在鉴别诊断的病例，未来可以考虑使用EUS-TA。为了区分PanNEN和IPAS，本研究显示，通过常规EUS评估钙化、通过EUS-EG评估硬度以及通过CH-EUS评估增强模式是有用的，且无需收集病理标本。

Therefore, EUS findings obtained from this study may allow the omission of EUS-TA with a bleeding risk for hypervascular masses and may be able to differentiate cases in which EUS-TA does not provide a pathological diagnosis..

因此，本研究获得的EUS检查结果可能允许省略对富血管肿块有出血风险的EUS-TA，并能够区分EUS-TA无法提供病理诊断的情况。

The limitations of this study are that it was a single-center, retrospective study of a relatively small number of patients. The study period was long, and various ultrasound endoscopes and ultrasound observation devices were used. In addition, not all patients underwent EUS-EG and CH-EUS, images were not stored for all CH-EUS phases, and grading with only EUS-TA was performed in a few patients in the PanNEN group although concordant PanNEN grading between EUS-TA specimens and surgical specimens was not obtained in some patients.

本研究的局限性在于，它是一项单中心、回顾性研究，涉及的患者数量相对较少。研究周期较长，使用了各种超声内镜和超声观察设备。此外，并非所有患者都接受了EUS-EG和CH-EUS检查，不是所有CH-EUS阶段的图像都保存完整，尽管在部分患者中EUS-TA标本与手术标本之间的PanNEN分级并不一致，但仅对少数PanNEN组患者进行了EUS-TA分级。

. A larger, multi-institutional study would be valuable for confirming EUS findings obtained from this study and strengthening the following conclusions.

一项更大规模、多机构的研究将有助于确认本研究中获得的EUS结果，并加强以下结论。

Although it is often difficult to differentiate between PanNEN and IPAS before surgery, this study showed that it is useful to evaluate calcification with conventional EUS, stiffness with EUS-EG, and enhancement patterns with CH-EUS. By using these findings obtained from this study, unnecessary surgery for patients with IPAS could be avoided..

虽然在手术前通常很难区分PanNEN和IPAS，但本研究表明，使用常规EUS评估钙化、EUS-EG评估硬度以及CH-EUS评估增强模式是有用的。通过使用本研究获得的这些结果，可以避免对IPAS患者进行不必要的手术。

Data availability

数据可用性

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

当前研究中使用和/或分析的数据集可根据合理要求从通讯作者处获取。

References

参考文献

Fatma, Y., Fazli, E., Mehmet, K. & Melike, R. M. Asymptomatic mass in the tail of the pancreas: Intrapancreatic accessory spleen (IPAS).

Fatma, Y., Fazli, E., Mehmet, K. & Melike, R. M. 胰腺尾部无症状肿块：胰腺内副脾（IPAS）。

Arch Iran Med.

伊朗医学档案。

, 574–576 (2022).

，574-576页（2022年）。

Article

文章

MATH

数学

Google Scholar

谷歌学术索

Elisabeth, V. et al. Intrapancreatic accessory spleen mimicking pancreatic NET: Can unnecessary surgery be avoided?.

Elisabeth, V. 等。胰腺内副脾模拟胰腺神经内分泌肿瘤：能否避免不必要的手术？

Acta Clin. Belg.

临床比利时杂志

, 492–495 (2021).

，492-495页（2021年）。

Article

文章

Google Scholar

谷歌学术

Sumi, H. et al. Preliminary study on evaluation of the pancreatic tail observable limit of transabdominal ultrasonography using a position sensor and CT-fusion image.

Sumi, H. 等。使用位置传感器和CT融合图像对经腹超声检查胰尾可视极限的初步研究。

Eur. J. Radiol.

欧洲放射学杂志

, 1324–1331 (2014).

，1324-1331（2014）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

Lloyd, R. V., Osamura, R. Y., Kloppel, G. & Rosai, J.

劳埃德，R. V.，欧萨穆拉，R. Y.，克洛佩尔，G.，罗赛，J.

WHO Classification of Tumours of Endocrine Organs

WHO内分泌器官肿瘤分类

4th edn. (International Agency for Research on Cancer, 2017).

第4版（国际癌症研究机构，2017年）。

MATH

数学

Google Scholar

谷歌学术索

Terminology, Diagnostic Criteria Committee, Japan Society of Ultrasonics in Medicine. Ultrasonographic diagnostic criteria for pancreatic cancer.

术语、诊断标准委员会，日本医学超声学会。胰腺癌的超声诊断标准。

J. Med. Ultrason.

医学超声杂志

, 497–504 (2013).

，497-504页（2013年）。

Article

文章

Google Scholar

谷歌学术

Chen, K. et al. Simple vascular architecture classification in predicting pancreatic neuroendocrine tumor grade and prognosis.

陈凯等。简单的血管结构分类在预测胰腺神经内分泌肿瘤分级和预后中的应用。

Dig. Dis. Sci.

消化科学杂志

, 3147–3152 (2018).

，3147-3152（2018）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

Kataoka, K. et al. Endoscopic ultrasound elastography for small solid pancreatic lesions with or without main pancreatic duct dilation.

片冈，K. 等。内镜超声弹性成像对伴或不伴主胰管扩张的小型胰腺实性病变的应用。

Pancreatology

胰腺学

, 451–458 (2021).

，451-458页（2021年）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术

Ishikawa, T. et al. Multiphase evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic solid lesions.

石川，T. 等。多相评估对比增强内镜超声在胰腺实性病变诊断中的应用。

Pancreatology

胰腺学

, 291–297 (2018).

，291-297页（2018年）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术索

Kanda, Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics.

神田，Y. 调查用于医学统计的免费易用软件“EZR”。

Bone Marrow Transplant.

骨髓移植。

, 452–458 (2013).

，452-458页（2013年）。

Article

文章

CAS

中国科学院

PubMed

MATH

数学

Google Scholar

谷歌学术

Giovannini, M. et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: A multicenter study.

乔瓦尼尼，M. 等。内镜超声弹性成像评估淋巴结和胰腺肿块：一项多中心研究。

World J. Gastroenterol.

世界胃肠病学杂志

, 1587–1593 (2009).

，1587-1593（2009）。

Article

文章

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术搜索

Ignee, A. et al. Endoscopic ultrasound elastography of small solid pancreatic lesions: A multicenter study.

Ignee, A. 等。小实性胰腺病变的内镜超声弹性成像：一项多中心研究。

Endoscopy

内窥镜检查

, 1071–1079 (2018).

，1071-1079（2018）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术索

Iglesias-Garcia, J., Larino-Noia, J., Abdulkader, I., Forteza, J. & Dominguez-Munoz, J. E. EUS elastography for the characterization of solid pancreatic masses.

伊格莱西亚斯-加西亚，J.，拉里诺-诺亚，J.，阿卜杜勒卡德尔，I.，福尔特扎，J.，多明格斯-穆尼奥斯，J. E. 超声内镜弹性成像在胰腺实性肿块的特性分析中的应用。

Gastrointest. Endosc.

胃肠内镜检查。

, 1101–1108 (2009).

，1101-1108页（2009年）。

Article

文章

PubMed

Google Scholar

谷歌学术索

Palazzo, M. et al. Contrast harmonic EUS for the prediction of pancreatic neuroendocrine tumor aggressiveness (with videos).

帕拉佐，M. 等。对比谐波EUS预测胰腺神经内分泌肿瘤的侵袭性（附视频）。

Gastrointest. Endosc.

胃肠内镜。

, 1481–1488 (2018).

，1481–1488（2018）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术索

Matsubara, H. et al. Dynamic quantitative evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic diseases.

松原，H. 等。动态定量评估对比增强内镜超声在胰腺疾病诊断中的应用。

Pancreas

胰腺

, 1073–1079 (2011).

，1073-1079（2011）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术索

Gong, T. T., Hu, D. M. & Zhu, Q. Contrast-enhanced EUS for differential diagnosis of pancreatic mass lesions: A meta-analysis.

龚婷婷、胡大明、朱强。增强对比超声内镜在胰腺肿块病变鉴别诊断中的应用：一项荟萃分析。

Gastrointest. Endosc.

胃肠内镜检查

, 301–309 (2012).

，301-309页（2012年）。

Article

文章

PubMed

MATH

数学

Google Scholar

谷歌学术搜索

He, X. K., Ding, Y. & Sun, L. M. Contrast-enhanced endoscopic ultrasound for differential diagnosis of pancreatic cancer: An updated meta-analysis.

何祥康、丁莹、孙立民。对比增强内镜超声在胰腺癌鉴别诊断中的应用：一项更新的荟萃分析。

Oncotarget

肿瘤靶标

, 66392–66401 (2017).

，66392–66401（2017）。

Article

文章

PubMed

PubMed Central

Google Scholar

谷歌学术

Kitano, M. et al. Characterization of small solid tumors in the pancreas: The value of contrast-enhanced harmonic endoscopic ultrasonography.

北野，M. 等。胰腺小实体肿瘤的特征：增强谐波内镜超声的价值。

Am. J. Gastroenterol.

美国胃肠病学杂志

107

, 303–310 (2012).

，303-310页（2012年）。

Article

文章

ADS

PubMed

MATH

数学

Google Scholar

谷歌学术

Ishigami, K. et al. Superparamagnetic iron-oxide-enhanced diffusion-weighted magnetic resonance imaging for the diagnosis of intrapancreatic accessory spleen.

石垣，K. 等。超顺磁性氧化铁增强扩散加权磁共振成像用于胰腺内副脾的诊断。

Abdom. Radiol.

腹部放射学

, 3325–3335 (2019).

，3325–3335（2019）。

Article

文章

MATH

数学

Google Scholar

谷歌学术

Gabriel, M. et al. 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: Comparison with somatostatin receptor scintigraphy and CT.

加布里埃尔，M. 等。68Ga-DOTA-Tyr3-奥曲肽 PET 在神经内分泌肿瘤中的应用：与生长抑素受体显像和CT的比较。

J. Nucl. Med.

核医学杂志

, 508–518 (2007).

，508-518（2007）。

Article

文章

CAS

中国科学院

PubMed

MATH

数学

Google Scholar

谷歌学术

Kataoka, K. et al. Differentiation between pancreatic metastases from renal cell carcinoma and pancreatic neuroendocrine neoplasm using endoscopic ultrasound.

片冈，K. 等。使用内镜超声区分肾细胞癌胰腺转移和胰腺神经内分泌肿瘤。

Pancreatology

胰腺学

, 1364–1370 (2021).

，1364-1370（2021）。

Article

文章

CAS

中国科学院

PubMed

MATH

数学

Google Scholar

谷歌学术

Schreiner, A. M., Mansoor, A., Faigel, D. O. & Morgan, T. K. Intrapancreatic accessory spleen: Mimic of pancreatic endocrine tumor diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy.

Schreiner, A. M., Mansoor, A., Faigel, D. O. & Morgan, T. K. 胰腺内副脾：通过内镜超声引导下细针穿刺活检诊断的胰腺内分泌肿瘤模拟物。

Diagn. Cytopathol.

诊断细胞病理学

, 262–265 (2008).

，262-265页（2008年）。

Article

文章

PubMed

Google Scholar

谷歌学术索

Kitano, M. et al. Needle tract seeding after endoscopic ultrasound-guided tissue acquisition of pancreatic tumors: Nationwide survey in Japan.

北野，M. 等。超声内镜引导下胰腺肿瘤组织获取后的针道种植：日本全国调查。

Dig. Endosc.

数字内窥镜。

, 1442–1455 (2022).

，1442-1455（2022）。

Article

文章

MATH

数学

Google Scholar

谷歌学术

Yane, K. et al. Non-negligible rate of needle tract seeding after endoscopic ultrasound-guided fine-needle aspiration for patients undergoing distal pancreatectomy for pancreatic cancer.

Yane, K. 等。胰腺癌患者在接受远端胰腺切除术前，经内镜超声引导细针穿刺后针道种植的非可忽略率。

Dig. Endosc.

数字内窥镜。

, 801–811 (2020).

，801-811页（2020年）。

Article

文章

PubMed

Google Scholar

谷歌学术索

Katanuma, A. et al. Factors predictive of adverse events associated with endoscopic ultrasound-guided fine needle aspiration of pancreatic solid lesions.

加藤沼，A. 等。与超声内镜引导下胰腺实性病灶细针穿刺相关的不良事件预测因素。

Dig. Dis. Sci.

消化道疾病科学

, 2093–2099 (2013).

，2093-2099（2013）。

Article

文章

CAS

中国科学院

PubMed

PubMed Central

MATH

数学

Google Scholar

谷歌学术

Kamata, K. et al. Histological diagnosis and grading of pancreatic neuroendocrine tumor by endoscopic ultrasound-guided fine needle biopsy using a 25-gauge needle with a core trap: A multicenter prospective trial.

龟田医疗中心等部门通过使用带有核心陷阱的25号针进行内镜超声引导下的细针穿刺活检，对胰腺神经内分泌肿瘤进行组织学诊断和分级：一项多中心前瞻性试验。

Pancreatology

胰腺学

, 1428–1433 (2020).

，1428-1433（2020）。

Article

文章

PubMed

Google Scholar

谷歌学术

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Acknowledgements

致谢

The study received support from JST (Moonshot R&D) (Grant Number. JPMJMS2214-11).

该研究得到了JST（Moonshot R&D）的支持（资助编号：JPMJMS2214-11）。

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Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

日本爱知县名古屋市昭和区鹤町65番地，名古屋大学医学院研究生院胃肠病学与肝病学系，邮编466-8550

Yuichi Kano, Takuya Ishikawa, Kentaro Yamao, Yasuyuki Mizutani, Kota Uetsuki, Takeshi Yamamura, Kazuhiro Furukawa & Hiroki Kawashima

加野佑一、石川拓也、山尾健太郎、水谷康之、上月孝太、山村武史、古川和宏、川岛弘辉

Department of Endoscopy, Nagoya University Hospital, Nagoya, Aichi, Japan

日本爱知县名古屋市名古屋大学医院内镜科

Tadashi Iida & Masanao Nakamura

饭田正义 & 中村正直

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Yuichi Kano

加野佑一

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Takuya Ishikawa

石川拓也

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Kentaro Yamao

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Yasuyuki Mizutani

水谷靖之

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Kota Uetsuki

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Takeshi Yamamura

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Kazuhiro Furukawa

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Contributions

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Study concept and design: Kano Y Analysis and interpretation of the data: Kano Y, Yamamura T, Furukawa K, and Nakamura M Drafting of the article: Kano Y, Ishikawa T, Yamao K, Mizutani Y, Iida T, Uetsuki K, and Kawashima H Critical revision of the article for important intellectual content: all authors Final approval of the article: all authors..

研究概念与设计：加野Y 数据分析与解释：加野Y、山村T、古川K、中村M 文章起草：加野Y、石川T、山尾K、水谷Y、饭田T、上月K、川岛H 对文章重要智力内容的批判性修订：所有作者文章最终批准：所有作者。

Corresponding author

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Correspondence to

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Takuya Ishikawa

石川拓也

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The authors declare no competing interests.

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Consent statements

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Due to the retrospective nature of the study, the Ethics Review Committee of Nagoya University Hospital (Approval Number: 2015–0316) waived the need of obtaining informed consent.

由于本研究为回顾性研究，名古屋大学医院伦理审查委员会（批准号：2015-0316）豁免了获取知情同意的要求。

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Kano, Y., Ishikawa, T., Yamao, K.

加诺，Y.，石川，T.，山尾，K.

et al.

等。

Usefulness of endoscopic ultrasonography for differentiating between non-functional pancreatic neuroendocrine neoplasm and intrapancreatic accessory spleen.

超声内镜在鉴别无功能性胰腺神经内分泌肿瘤与胰腺内副脾中的作用。

Sci Rep

科学报告

, 6385 (2025). https://doi.org/10.1038/s41598-025-91272-w

，6385（2025）。https://doi.org/10.1038/s41598-025-91272-w

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18 December 2024

2024年12月18日