胰腺疾病中影响超声内镜引导下细针抽吸活检(EUS-FNA)诊断能力的潜在因素

 目的 前瞻性地评价超声内镜引导下细针抽吸活检 (endoscopic ultrasound guided fine needle aspiration, EUS FNA)在胰腺疾病诊断中的价值及影响其诊断能力的潜在因素分析。方法 2010年9月至2011年8月间就诊于复旦大学附属中山医院内镜中心,经影像学诊断(CT或MRI)为胰腺病变、拟行EUS FNA的44例患者连续性地纳入本研究。详细记录患者的年龄、性别、病变位置、病变大小、穿刺次数,评价是否获取足够样本供细胞学或组织病理学诊断及穿刺相关并发症等。 结果 44例患者中,42例成功实行EUS FNA(95.5%, 42/44),病灶的平均最大直径为(44.7±18.2)mm。31例获得肉眼可见的组织条;意向性分析结果显示,34例穿刺样本(77.3%, 34/44)足够用于细胞或组织病理学诊断,包括31例患者获得明确的细胞或组织病理学恶性肿瘤依据,3例诊断为胰腺炎症。病灶的位置、大小与穿刺成功率、明确病理学诊断的获得率无明显关系;而穿刺过程中获得肉眼可见组织样本病例的明确病理学诊断获得率明显高于未获得者(P= 0.000)。2例患者于穿刺时发生穿刺点渗血 (4.8%, 2/42),通过电凝及止血夹处理好转。结论 在胰腺疾病的诊断中,EUS FNA具有良好的安全性和有效性。如何在安全的前提下获取更多的组织量用于病理学评估是提高EUS FNA诊断能力的关键。

Potential factors of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) associated with percentage of classifying pathologic diagnosis for pancreatic diseases

Objective To investigate the clinical impact of endoscopic ultrasound guided fine needle aspiration (EUS FNA) for the diagnosis of pancreatic diseases and potential factors associated with the percentage of classifying pathologic diagnosis in a prospective study.Methods Consecutive patients with indeterminate pancreatic diseases underwent EUS and EUS FNA. The characteristics of patients and lesions, potential factors associated with the percentage of classifying pathologic diagnosis and complications were evaluated.Results Of 44 patients who underwent EUS, FNA was performed in 42 cases (95.5%), and the average maximum diameter of the lesions was (44.7±18.2) mm. Macroscopical tissue samples were obtained in 31 cases. Specimens sent for cytology or histopathology provided adequate material in 34 cases,accounting for an intention to diagnose yield of 77.3% (34/44). Patients with visible tissue samples had a higher percentage of classifying pathologic diagnosis (P=0.000). Errhysis at the point of puncyure occurred in 2 patients (4.8%,2/42), and were controlled by electric coagulation and hemostatic forceps.Conclusions EUS FNA appeared to be a safe, feasible and effective procedure for the diagnosis of pancreatic diseases. The development of new techniques to obtain more samples for pathological analysis may well be valuable.