遠藤 正章¹, 仲地 広美智¹, 志田 正一¹, 井上 茂章¹, 羽田 隆吉¹, 鈴木 英登士¹, 佐々木 睦男¹, 栗田 武彰², 杉山 譲¹, 今 充¹

Masaaki ENDOH¹, Hiromichi NAKACHI¹, Syoichi SHIDA¹, Shigeaki INOUE¹, Ryukichi HADA¹, Hidetoshi SUZUKI¹, Mutsuo SASAKI¹, Takeaki KURITA², Yuzuru SUGIYAMA¹, Mitsuru KONN¹

¹弘前大学医学部第二外科, ²木造成人病センター外科

¹The Second Department of Surgery, Hirosaki University School of Medicine, ²Department of Surgery, Kizukuri Adult Disease Center Hospital

キーワード : Endoscopic ultrasonography, Cancer of the biliary tract, Ampullary cancer, Pancreatic cancer, Diagnosis of cancer extension

The accuracy of endoscopic ultrasonography (EUS) in diagnosis of extent of an invasive spread from biliary or pancreatic cancer was compared with that of ordinary US.
A total of 32 cases (7 gallbladder; 12 bile duct; 3 ampullary and 10 pancreatic cancers) were examined. Because of each one failure in detecting with US for an ampullary cancer and with EUS for a cancer of the hilar bile duct, the overall visualization rate of the lesion with EUS (97%) was equal to that with US. Nonetheless, EUS could give a definitely higher resolution of ultrasonic images that was enough to visualize the layer-structure of the wall of the gallbladder (GB), bile duct (BD), stomach and duodenum and to depict the great vessels and surrounding tissues. When the one case not visualized by EUS was excluded, the detection rate of cancer invasion by EUS (55%) exceeded that given by US (43%). EUS clearly demonstrated a spread from GB cancer to the liver by 3/4; to the BD by 2/3; to the portal vein (PV) by 1/1 and to the duodenum by 3/3. In the cases of BD cancer, the successful detections of a malignant spread to the GB and PV were 3/4 and 2/5 respectively. In ampullary cancer, the detection rates of the invasion of to the surrounding organs were 2/2 for the BD; 2/2 for the pancreatic duct and 2/3 for the duodenum. The diagnostic accuracy of EUS for the spread from pancreatic cancer to the PV and wall of the stomach were 6/9 and 3/3. Swollen lymph nodes could also be definitely detected by EUS.
From our clinical results, EUS seems to be an useful tool in diagnosis of invasive spreads from cancer of the bilio-pancreatic system.