细针直径对内镜超声下胰腺实性占位穿刺诊断影响的研究

目的 研究不同细针直径对内镜超声(EUS)引导下细针穿刺(FNA)胰腺实性占位诊断的影响.方法 选择临床及影像学疑诊胰腺实性占位患者共37例,分别用19G和22G穿刺针进行穿刺.结果 EUS检出全部37例胰腺占位,16例患者经22G穿刺针行FNA,11例获得满意标本;21例患者经19G穿刺针行FNA,均获得满意标本.32例获得病理诊断,其中3例误诊为慢性胰腺炎.结论 EUS能有效检出胰腺占位,穿刺针大小为穿刺组织病理诊断成功的影响因素,慢性胰腺炎是影响病理诊断的重要因素.     

内镜超声引导细针穿刺对胰腺癌的诊断价值

目的了解内镜超声(EUS)引导细针穿刺(FNA)对胰腺癌的临床价值及安全性。方法选择临床诊断或临床及影像学疑诊胰腺癌患者共21例,男13例,女8例,平均年龄(59.8±15.3)岁。EUS发现病变后,在实时超声引导下用超声穿刺针行FNA,对3例无法手术的胰腺癌患者行FNA同时,以无水乙醇阻滞腹腔神经丛治疗癌痛。结果B超共检出胰腺占位16例(16/21),未检出的5例中3例经CT检出,CT共检出胰腺占位19例;EUS检出全部21例胰腺占位,5例位于胰体尾,16例位于胰头。18例患者EUS-FNA获满意标本,17例诊断为胰腺癌,1例诊断为慢性胰腺炎,胰腺癌诊断敏感性为85.0%、特异性为100.0%、准确度为85.7%。3例行无水乙醇阻滞后疼痛减轻。术后发生轻度胰腺炎1例、发热1例。结论EUS能有效检出胰腺占位,结合FNA可提高诊断的特异性及准确性。     

内镜超声引导下细针穿刺活检对胰腺占位性病变的诊断价值

目的探讨内镜超声引导下细针穿刺活检（EUS—FNA）对胰腺占位性病变的诊断价值。方法从1998年10月至2006年9月，对190例胰腺占位病灶进行了超声内镜引导下穿刺活检，进行细胞学或病理学诊断。结果（1）2006年1月以前未采用床旁染色观察时，EUS—FNA诊断胰腺癌的敏感性为67．6％。2006年1月以后采用病理医师床旁瑞氏-姬姆萨快速染色观察法，EUS—FNA诊断胰腺癌的敏感性提高到93.1％。（2）18例胰腺小占位病灶行EUS—FNA，其诊断准确率是66．7％。（3）胰腺癌患者组中EUS—FAN活检物中的CEA、CA19-9浓度明显高于血清中的浓度。（4）EUS—FNA对假肿瘤性胰腺炎诊断的准确率为76．5％。结论EUS—FNA对胰腺占位性病灶的诊断是安全有效的，具有重要价值。     

细胞块结合免疫组化在内镜超声引导下穿刺诊断胰腺实性占位中的应用价值

目的探讨超声内镜引导下细针穿刺（EUS—FNA）物行不同细胞学检查方法对胰腺占位性病变的诊断价值。方法前瞻性研究广西医科大学第一附属医院2012年3月至2013年6月收治的胰腺实性占位性病变72例,均行超声内镜引导下细针穿刺活检取材,分别行常规涂片、液基涂片及细胞块结合免疫组化检查。结果72例患者中,最终确诊胰腺肿瘤61例,包括胰腺癌55例、胰腺假乳头状瘤2例、胰腺内分泌肿瘤4例;良性病变11例,包括慢性胰腺炎4例、胰腺结核2例、胰腺炎4例、黏液性囊腺瘤1例。常规涂片、液基涂片和细胞块结合免疫组化对胰腺肿瘤的诊断敏感度分别为68．9％（42／61）、75．4％（46／61）和90．2％（55／61）,特异度均为100．0％,准确率分别为73．6％（53／72）、79．2％（57／72）和91．7％（66／72）,细胞块结合免疫组化诊断准确率高于常规涂片细胞学及液基细胞学（P均〈0．05）。术后患者均无出血、感染、急性胰腺炎等并发症。结论EUS—FNA是一种安全有效的诊断胰腺占位病变的方法,具有高敏感度和特异度。EUS—FNA细胞块结合免疫组化有助于胰腺实性占位病变的定性诊断和组织学分型诊断,对治疗方案的选择有较大的临床应用价值。     

内镜超声引导下细针穿刺活检对占位性病变的诊断价值

背景：内镜超声引导下细针穿刺活检（EUS—FNA）广泛应用于占位性病变的诊断,但其诊断价值尚未完全明确。目的：评价EUS—FNA对占位性病变的诊断价值。方法：纳入2010年12月～2012年12月于华中科技大学同济医学院附属协和医院就诊的占位性病变患者70例,对占位性病变行EUS—FNA检查,以术后病理诊断作为金标准,评价EUS·FNA的阳性预测值、阴性预测值、敏感性、特异性、准确性以及约登指数。结果：66例患者获得足够细胞或组织学标本,穿刺成功率为94．3％。穿刺成功患者（66例）中,EUS—FNA的阳性预测值、阴性预测值、敏感性、特异性、准确性、约登指数分别为100％、36．4％、88．7％、100％、89．4％和0．887;所有穿刺患者（70例）中,上述数值分别为100％、26．7％、83．3％、100％、84．3％和0．833。所有患者均未发生严重并发症。结论：EUS—FNA对诊断占位性病变安全、有效,具有重要临床价值。     

超声内镜引导细针穿刺活检对胰腺占位性病变的诊断价值

目的探讨超声内镜引导下细针穿刺活检(EUS-FNA)对胰腺占位性病变的诊断价值。方法回顾分析2009年1月至2010年1月间行EUS-FNA的35例胰腺占位病例,与CT、B超、临床表现等进行对比分析,依病理学和细胞学检查或随访结果确诊。结果在所有35例患者中,最后确诊胰腺癌23例、慢性胰腺炎9例、导管内黏液性乳头状瘤1例、胰腺假性囊肿1例、浆液性囊腺瘤1例。B超共检出胰腺病变22例,CT29例,EUS发现35例可疑胰腺病变。对所有患者均行EUS-FNA检查,获得满意标本34例,取材满意率97.14%。EUS-FNA诊断胰腺癌17例,敏感性为73.91%,EUS-FNA总准确率为82.86%。5例患者EUS-FNA后出现淀粉酶及脂肪酶轻度升高,治疗后很快恢复正常。结论 EUS-FNA是病理学诊断胰腺占位性病变安全而有效的方法,应作为首选。     

超声内镜引导下细针穿刺病理诊断慢性胰腺炎的临床研究

目的为了获得病理组织学诊断慢性胰腺炎，根据临床表现、影像学和外分泌功能检查临床疑为慢性胰腺炎的47例患者，采用超声内镜引导下对胰腺行细针穿刺取得组织而进行病理学诊断。方法47例患者，男28例、女19例，年龄47～69岁，平均52．3岁，病程在3～21年之间，平均6．3年，临床疑为慢性胰腺炎、胰腺占位病变，并进行了相应的N-苯甲酰-L酪氨酰对氨苯甲酸(BT—PABA)试验、大便苏丹Ⅲ染色及胰腺CT检查的患者行超声内镜引导下细针穿刺(EUS-FNA)，取得组织，进行病理学诊断。结果47例患者中，EUS-FNA的病理组织学诊断慢性胰腺炎为31例(31／47、69％)。结论通过EUS-FNA进行病理学诊断，解决了以往慢性胰腺炎只有临床诊断没有病理诊断难题，从而为临床提供了诊断慢性胰腺炎的有效方法。     

胰腺囊性占位的影像学诊断比较研究

目的比较EUS、CT、ERCP、MRCP对胰腺囊性占位的诊断. 方法对46例胰腺囊性占位患者行EUS检查,并同时行CT、ERCP、MRCP、体表超声等检查,并对9例患者行EUS(B超)引导下胰腺囊性占位细针穿刺活检术.     

内镜超声引导下细针穿刺抽吸术在纵隔病变诊断中的应用

目的 初步探讨内镜超声引导下细针穿刺抽吸术(EUS-FNA)在纵隔肿大淋巴结、纵隔不明原因占位定性诊断及肺癌N分期中的应用价值.方法 应用22 G穿刺针对61例患者经食管行EUS.FNA,穿刺物均行病理及细胞学检查.结果 EUS·FNA诊断阳性率为93.4%(57/61),细胞学及病理诊断阳性率分别为85.2%(52/61)和83.6%(51/61).100.0%(26/26)临床疑诊肺癌纵隔淋巴结转移而经支气管镜等检查未能提供病理或细胞学证据者均通过EUS-FNA得到诊断,其中21例诊断为肺癌、5例排除肺癌诊断为良性疾病;86.4%(19/22)纵隔不明原因占位明确定性;85.7%(6/7)有恶性肿瘤病史影像学检查疑诊纵隔淋巴结转移者,EUS-FNA病理及细胞学结果 支持转移;6例经支气管镜检查已获得明确病理细胞学诊断的肺癌病例但影像学提示纵隔淋巴结肿大,为明确N分期行EUS-FNA,结果 均为阳性,改变了原计划治疗方案.本组无一例EUS-FNA相关并发症发生.结论 对于明确纵隔肿大淋巴结、纵隔不明原因占位定性诊断及肺癌N分期,EUS-FNA是一种较为安全、有效的诊断方法.     

内镜超声引导下细针穿刺抽吸术对胰腺占位病变诊断价值及其影响因素的研究

目的探讨内镜超声引导下细针穿刺抽吸术（EUS—FNA）对胰腺占位病变的诊断价值及影响其准确率的相关因素。方法回顾性统计101例因胰腺占位病变行EUS—FNA患者的临床资料,纳入患者性别、年龄、病灶部位、大小、性状、穿刺时抽吸负压、穿刺次数、实时细胞学诊断、超声内镜类型、操作医师经验等10个因素进行分析。结果EUS-FNA总体诊断准确率为85．1％,敏感度为81．1％,特异度为96．3％,阳性预测值为98．4％,阴性预测值为65．0％。单因素Logistic回归分析示,EUS-FNA穿刺阳性率的相关影响因素有病灶大小、病灶性状、抽吸负压、操作医师经验（P〈0．05）,EUS-FNA诊断准确率的相关影响因素只有病灶大小（OR=1．984,95％CI：1．141—3．451,P=0．015）,病灶每增大1cm,其穿刺阳性的概率增加1．67倍,其穿刺诊断准确的概率增加1．83倍。多因素Logistic回归分析显示,EUS．FNA穿刺阳性率的独立影响因素有病灶大小（OR=2．012,95％CI：1．394—2．906,P=0．000）和病灶性状（OR=10．218,95％CI：2．432～42．937,P=0．002）,实性病灶穿刺阳性的概率为囊性病灶的10．2倍;EUS—FNA诊断准确率的独立影响因素为病灶大小（OR=1．984,95％CI：1．141—3．451,P=0．015）。结论EUS．FNA是一项安全有效、特异度高的诊断手段,在胰腺占位病灶的病理诊断中具有重要临床价值。EUS-FNA穿刺阳性率及诊断准确率均与胰腺病灶大小呈显著正相关。胰腺实性病灶的穿刺阳性率显著高于囊性病灶。     

内镜超声引导下细针穿刺对胰腺占位病变的诊断价值

目的 通过超声内镜结合细针穿刺活检确定胰腺占位病变的性质，并评价该法对胰腺病变的诊断价值。方法 对经CT、MRI、体表腹部超声及内镜超声发现的23例胰腺局限性占位病变进行内镜超声检查，以明确病变大小、形态、位置，并观察有无淋巴结转移。在内镜超声引导下对病变行细针穿刺活检。结果 23例患者中，21例得到了充足的细胞量，15例得到组织块，12例最终确定为胰腺肿瘤的患者，经组织细胞学检查10例为阳性（其中胰腺癌8例；胰腺囊腺瘤癌1例；无功能神经内分泌肿瘤1例），敏感性为83％，特异性为100％。全部结果经手术（16例）及临床随访（7例）证实。无1例出现不良反应。结论 超声内镜结合细针穿刺是诊断胰腺病变安全、有效的方法。     

内镜超声及其引导下的细针穿刺活检在胰腺疾病中的诊断价值

目的:探讨内镜超声(EUS)及其引导下的细针穿刺活检(EUS-FNA)在胰腺疾病诊断中的价值.方法:回顾性分析2008-03/2010-03经EUS检查的62例胰腺疾病,其中有32例行细针穿刺活检.结果:(1)62例胰腺疾病中胰腺癌26例、慢性胰腺炎20例、胰腺囊肿10例、胰岛细胞瘤2例;(2)B超、CT、EUS/EU...     

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

AIM To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) material in the differential diagnosis of pancreatic solid masses.METHODS Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs (22G needle) were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Materials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study.RESULTS Length of the core specimen obtained for histological analysis was 6.5 5.3 mm (range 1-22 mm).Cytological and histological samples were considered as adequate in 51 (82.3%) and 52 cases (83.9%), respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Contrary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases (90.3%),with a global sensitivity of 84.21%, specificity of 100%and an overall accuracy of 90.32%. The complication rate was 1.6%.CONCLUSION Adequate pancreatic core specimens for histological examination can be obtained by EUS-guided FNA. This technique is mainly useful for the diagnosis of different types of pancreatic tumours and evaluation of benign diseases.     

内镜超声引导下细针穿刺活检术在消化道管壁及其周围器官疾病诊断中的应用价值

目的 探讨内镜超声引导下细针穿刺活检在消化道管壁及其周围器官疾病诊断中的应用价值。方法 对2009年5月至2010年11月行EUS-FNA的133例患者(161处病灶)的临床和病理学资料进行回顾性总结。结果 161处穿刺部位中,实性病变142处,囊液性病变15处,胰腺囊实性病变4例。穿刺部位包括上消化道和直肠周围器官以...     

Factors affecting the diagnostic accuracy of endoscopic ultrasonography‐guided fine‐needle aspiration (EUS‐FNA) for upper gastrointestinal submucosal or extraluminal solid mass lesions

Aim: A number of potential variables are associated with the diagnostic accuracy of endoscopic ultrasonography‐guided fine‐needle aspiration (EUS‐FNA). The aim of this study was to evaluate factors affecting the diagnostic accuracy of EUS‐FNA for upper gastrointestinal submucosal or extraluminal solid lesions. Methods: Patients with such lesions who underwent EUS‐FNA between January 2009 and December 2010 were studied retrospectively. Needles of 22, 25 and 19 gauge were used. The associations between the EUS‐FNA results and factors such as mass location, mass size, needle size, number of needle passes, combined histologic‐cytologic analysis and final diagnosis were analyzed. Results: A total of 170 EUS‐FNA procedures were performed in 158 patients with upper gastrointestinal submucosal or extraluminal solid lesions. The overall accuracy of EUS‐FNA was 86.5% (147/170). The diagnostic accuracy with three or more needle passes was higher than with less than 3.0 needle passes (90.0%, 108/120 vs 78.0%, 39/50; P < 0.05). Mass location, mass size, and final diagnosis were not associated with EUS‐FNA accuracy. Combined cytologic‐histologic analysis had significantly higher diagnostic accuracy than either cytologic or histologic analysis alone (P < 0.001). In a subgroup of 90 patients, both 22 and 25 gauge needles were used for EUS‐FNA. The overall diagnostic accuracy was similar for 25 gauge needles and 22 gauge needles (80.0% vs 78.9% P = 1.000) in this subgroup. Conclusion: Overall, 25 and 22 gauge needles have a similar diagnostic accuracy. Our results suggest that 3.0 or more needle passes and combined cytologic‐histologic analysis enhance the diagnostic accuracy of EUS‐FNA.     

Role of endoscopy in the diagnosis of autoimmune pancreatitis and immunoglobulin G4‐related sclerosing cholangitis

Autoimmune pancreatitis (AIP) must be differentiated from pancreatic carcinoma, and immunoglobulin (Ig)G4‐related sclerosing cholangitis (SC) from cholangiocarcinoma and primary sclerosing cholangitis (PSC). Pancreatographic findings such as a long narrowing of the main pancreatic duct, lack of upstream dilatation, skipped narrowed lesions, and side branches arising from the narrowed portion suggest AIP rather than pancreatic carcinoma. Cholangiographic findings for PSC, including band‐like stricture, beaded or pruned‐tree appearance, or diverticulum‐like outpouching are rarely observed in IgG4‐SC patients, whereas dilatation after a long stricture of the bile duct is common in IgG4‐SC. Transpapillary biopsy for bile duct stricture is useful to rule out cholangiocarcinoma and to support the diagnosis of IgG4‐SC with IgG4‐immunostaining. IgG4‐immunostaining of biopsy specimens from the major papilla advances a diagnosis of AIP. Contrast‐enhanced endoscopic ultrasonography (EUS) and EUS elastography have the potential to predict the histological nature of the lesions. Intraductal ultrasonographic finding of wall thickening in the non‐stenotic bile duct on cholangiography is useful for distinguishing IgG4‐SC from cholangiocarcinoma. Endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) is widely used to exclude pancreatic carcinoma. To obtain adequate tissue samples for the histological diagnosis of AIP, EUS‐Tru‐cut biopsy or EUS‐FNA using a 19‐gauge needle is recommended, but EUS‐FNA with a 22‐gauge needle can also provide sufficient histological samples with careful sample processing after collection and rapid motion of the FNA needles within the pancreas. Validation of endoscopic imaging criteria and new techniques or devices to increase the diagnostic yield of endoscopic tissue sampling should be developed.     

Performance of endosonography-guided fine needle aspiration and biopsy in the diagnosis of pancreatic cystic lesions

OBJECTIVE: Preoperative diagnosis of cystic lesions of the pancreas remains difficult despite improvement in imaging modalities and cystic fluid analysis. The aim of our study was to assess the performance of endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (FNA) in the diagnosis of pancreatic cystic lesions. METHODS: Data from a series of 127 consecutive patients with pancreatic cystic lesions were prospectively studied. EUS and EUS-guided FNA were performed in all patients, and cystic material was used for cytological and histological analysis as well as for biochemical and tumor markers analysis. Performance of EUS diagnosis, biochemical and tumor markers, and FNA diagnosis were compared with the final histological diagnosis obtained at surgery or postmortem examination. Sixty-seven patients underwent surgery and therefore constituted our study group. RESULTS: EUS provided a tentative diagnosis in 113 cases (89%). Cytohistological FNA provided a diagnosis in 98 cases (77%). When the results of EUS and EUS-guided FNA were compared with the final diagnosis (67 cases), EUS correctly identified 49 cases (73%), whereas FNA correctly identified 65 cases (97%). Sensitivity, specificity, positive predictive value, and negative predictive value of EUS and EUS-guided FNA to indicate whether a lesion needed further surgery were 71% and 97%, 30% and 100%, 49% and 100%, and 40% and 95%, respectively. Carbohydrate antigen 19-9 > 50,000 U/ml had a 15% sensitivity and a 81% specificity to distinguish mucinous cysts from other cystic lesions, whereas it had a 86% sensitivity and a 85% specificity to distinguish cystadenocarcinoma from other cystic lesions. CONCLUSIONS: EUS-guided FNA is a valuable tool in the preoperative diagnostic assessment of pancreatic cystic lesions.     

EUS-guided core biopsies of pancreatic solid masses using a new fork-tip needle: A multicenter prospective study

Background and aimEndoscopic ultrasound-guided sampling (EUS sampling) is a safe and effective technique. The study aim was to evaluate the presence of a histological core from pancreatic lesions using a new 25G fork-tip needle.MethodsObservational multicenter prospective and analytical study, including consecutive patients with solid pancreatic masses referred for EUS-guided sampling. At each needle pass, the endoscopist performed macroscopic on-site evaluation (MOSE). The primary outcome was the histological core procurement rates. Secondary outcomes were the evaluation of interobserver agreement between endoscopists and pathologists, adequacy of EUS samples for the diagnosis and post-procedure adverse events.Results100 patients were enrolled in 3 centers. The mean size of the lesions was 28.5 mm (SD 11.7). Final diagnoses were adenocarcinoma (68%), neuroendocrine tumor (21%), inflammatory mass/benign lesions (8.0%), and pancreatic metastasis (3.0%). The pathologists described the presence of a core in 67 samples (67.0% of patients), with poor agreement with MOSE (kappa, 0. 12; 95% CI: 0.03–0.28). The diagnostic accuracy was 93%. We observed 6% of mild adverse events.ConclusionThe new 25-gauge core needle showed good overall adequacy and a good rate of histological specimens during EUS sampling of solid pancreatic masses, with a minimum number of passes and no major complications. Clinicaltrial.gov number, NCT02946840.     

Prospective evaluation of the optimal number of 25‐gauge needle passes for endoscopic ultrasound‐guided fine‐needle aspiration biopsy of solid pancreatic lesions in the absence of an onsite cytopathologist

Introduction: A prior study with 22‐gauge needles recommended more than seven needle passes for endoscopic ultrasound‐guided fine‐needle aspiration biopsy (EUS‐FNA) of solid pancreatic lesions (SPL) without onsite cytopathology for optimal acquisition of cytopathological diagnosis. The feasibility of this recommendation should be re‐evaluated considering the later development and popularity of 25‐gauge EUS‐FNA needles. We aimed to determine the optimal number of needle passes for cytopathological specimen acquisition with 25‐gauge needles for EUS‐FNA of SPL. Methods: A preliminary prospective study of 22 patients with an onsite cytopathology technician showed a sensitivity of 93.3% and a specificity of 100% with four needle passes that was not statistically different from five needle passes. Based on our preliminary study, we fixed the number of needle passes to four (Group A). As a control group, we carried out sampling in consecutive patients using 25‐gauge needles with an onsite cytopathologist (Group B). Sampling rate, diagnostic value and complications were evaluated. Results: We enrolled 20 patients in each group. Sampling rate was higher in Group B (20/20, 100%) than in Group A (19/20, 95%), but there was no statistical difference between them (P‐value = 0.31). In Group A, sensitivity, specificity and accuracy were 100% among 19. In Group B, sensitivity was 94.1%, specificity 100%, accuracy 95%. There were also no statistical differences between the groups. No complications were seen. Conclusion: Our study suggests that four needle passes using a 25‐gauge needle may be sufficient for EUS‐FNA of SPL where onsite cytology is not available.