Histological diagnosis of autoimmune pancreatitis using EUS-guided trucut biopsy: a comparison study with EUS-FNA
Histological diagnosis of autoimmune pancreatitis using EUS-guided trucut biopsy: a comparison study with EUS-FNA
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DOI：
10.1007/s00535-009-0062-6
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发表时间：
2009-07-01
影响因子：
6.3
通讯作者：
Yamao, Kenji
中科院分区：
文献类型：
--
作者：
Mizuno, Nobumasa;Bhatia, Vikram;Yamao, Kenji
目的 本研究的目的是评估超声内镜（EUS）引导下的特鲁切活检（TCB）诊断自身免疫性胰腺炎（AIP）的可行性和安全性。方法对 14 例影像学检查疑似 AIP 的患者进行超声内镜引导下细针穿刺活检（FNA）和 EUS-TCB 诊断 AIP 并排除自身免疫性胰腺炎。 胰腺癌（PC）。根据修订后的日本临床诊断标准，8名患者被诊断为AIP，其余6名患者患有其他病因的胰腺炎。病理上，AIP被定义为淋巴浆细胞硬化性胰腺炎（LPSP），并分为两种类型：显示LPSP全谱的确诊LPSP（d-LPSP）和不伴有闭塞性静脉炎或大量（> 10个细胞/hpf）IgG4阳性浆细胞浸润的可能LPSP（p-LPSP）。 排除在所有患者中。 EUS-FNA 结果显示，8 名 AIP 患者中有 3 名报告为 p-LPSP，1 名报告为正常，4 名未得出结论。六名非自身免疫性胰腺炎患者中的一名经 EUS-FNA 诊断为 p-LPSP，一名诊断为特发性慢性胰腺炎 (ICP)，四名诊断结果不确定。通过EUS-TCB，所有AIP患者均被诊断为LPSP（4 d-LPSP和4 p-LPSP）。在 6 名非自身免疫性胰腺炎患者中，3 名被诊断为 LPSP（1 d-LPSP 和 2 p-LPSP），3 名在 TCB 上显示 ICP。在任何接受 EUS-FNA 或 TCB 的患者中均未发现并发症。结论 EUS-TCB 是对疑似 AIP 患者进行组织学诊断的安全且准确的方法。 EUS-TCB 可以作为缺乏典型表现的 AIP 病例的救援技术。
Purpose The aim of this study was to evaluate the feasibility and safety of endoscopic ultrasonography (EUS)guided trucut biopsy (TCB) for diagnosis of autoimmune pancreatitis (AIP).Methods Fourteen patients with suspected AIP based on imaging studies underwent both EUS-guided fine-needle aspiration (FNA) and EUS-TCB for diagnosis of AIP and exclusion of pancreatic cancer (PC). According to the revised Japanese clinical diagnostic criteria, AIP was diagnosed in eight while the remaining six patients had pancreatitis of other etiologies. Pathologically, AIP was defined as lymphoplasmacytic sclerosing pancreatitis (LPSP), and sub-divided into two types: definite LPSP (d-LPSP) showing fulspectrum of LPSP and probable LPSP (p-LPSP) without obliterative phlebitis or abundant (> 10 cells/ hpf) IgG4-positive plasmacytes infiltration.Results PC was excluded in all patients. EUS-FNA resulted in three of eight patients with AIP were reported as p-LPSP, one was reported as normal, and 4 were inconclusive. One of six with non-autoimmune pancreatitis was diagnosed as p-LPSP on EUS-FNA, one as idiopathic chronic pancreatitis (ICP) and four were inconclusive. By using EUS-TCB, all AIP patients were diagnosed as LPSP (4 d-LPSP and 4 p-LPSP). Of the six patients with non-autoimmune pancreatitis, three were diagnosed as LPSP (1 d-LPSP and 2 p-LPSP) and three showed ICP on TCB. No complications were identified in any patient with either EUS-FNA or TCB.Conclusion EUS-TCB is a safe and accurate procedure for obtaining a histological diagnosis in patients with suspected AIP. EUS-TCB can serve as a rescue technique in cases of AIP lacking typical findings.