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

Yıl 2018, Cilt: 17 Sayı: 3, 104 - 109, 29.12.2018

Melike Ruşen Metin , Mustafa Tahtacı

https://doi.org/10.17941/agd.473867

Öz

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. 

Anahtar Kelimeler

Elastografi, pankreas, adenokanser, fokal pankreatit

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

Öz

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.

Anahtar Kelimeler

Elastography, pancreas, adeno ca, focal pancreatitis

Kaynakça

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