EUS-guided FNA diagnostic yield of malignancy in solid pancreatic masses: a benchmark for quality performance measurement
EUS-guided FNA diagnostic yield of malignancy in solid pancreatic masses: a benchmark for quality performance measurement
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DOI：
10.1016/j.gie.2007.01.017
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发表时间：
2007-08-01
影响因子：
7.7
通讯作者：
Behling, Cynthia
中科院分区：
文献类型：
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作者：
Savides, Thomas J.;Donohue, Michael;Behling, Cynthia
背景：EUS引导下的胰腺实体肿块FNA (EUS-FNA)的诊断率是EUS-FNA质量的潜在基准，因为大多数实体胰腺肿块的EUS-FNA应该可以诊断恶性肿瘤。目的：确定实体胰腺肿块的EUS-FNA中恶性肿瘤的细胞学诊断率，并确定内窥镜医师和中心之间是否存在差异。设计：多中心回顾性研究。患者：EUS中心提供细胞学检查报告一年内所有实性、非囊性、直径 >= 10 毫米、实性胰腺肿块的 EUS-FNA。主要结果测量：胰腺恶性肿瘤的细胞学诊断。结果：共有 1075 名患者在 21 个中心（81% 为学术人员）接受了 EUS-FNA，共有 41 名内镜医师。年内，每个中心对胰腺实性肿块进行 EUS-FNA 的中位数为 46 例（范围，4-177 例），每位内窥镜医生为 19 例（范围，1-97 例）。平均质量尺寸为 32 x 27 毫米，其中 73% 位于头部。平均传球次数为 3.5 次。在这些中心中，90% 采用了立即细胞学评估。恶性肿瘤总体诊断率为71%，95%置信区间为0.69%-0.74%，其中5%可疑恶性肿瘤，6%非典型细胞，18%恶性肿瘤阴性。每个中心的中位诊断率为 78%（范围，39%-93%；第一四分位数，61%），每个内窥镜医师的中位诊断率为 75%（范围，0%-100%；第一四分位数，52%）。局限性：回顾性研究、参与偏倚和不同的慢性胰腺炎患病率。结论：（1）EUS-FNA 细胞学诊断为 71% 的恶性肿瘤(2) 胰腺实性肿块的 EUS-FNA 最终细胞学诊断恶性肿瘤率低于 52% 的肠镜医师处于最低四分位数，应评估其低产量的原因。
Background: The diagnostic yield of EUS-guided FNA (EUS-FNA) of solid pancreatic masses is a potential benchmark for EUS-FNA quality, because the majority of EUS-FNA of solid pancreatic masses should be diagnostic for malignancy.Objectives: To determine the cytologic diagnostic rate of malignancy in EUS-FNA of solid pancreatic masses and to determine if variability exists among endoscopists and centers.Design: Multicenter retrospective study.Patients: EUS centers provided cytology reports for all EUS-FNAs of solid, noncystic, >= 10-mm-diameter, solid pancreatic masses during a 1-year period.Main Outcome Measurement: Cytology diagnostic of pancreatic malignancy.Results: A total of 1075 patients under-went EUS-FNA at 21 centers (81% academic) with 41 endoscopists. The median number of EUS-FNA of solid pancreatic masses performed during the year per center was 46 (range, 4-177) and per endoscopist was 19 (range, 1-97). The mean mass dimensions were 32 x 27 mm, with 73% located in the head. The mean number of passes was 3.5. Of the centers, 90% used immediate cytologic evaluation. The overall diagnostic rate of malignancy was 71%, 95% confidence interval 0.69%-0.74%, with 5% suspicious for malignancy, 6% atypical cells, and 18% negative for malignancy. The median diagnostic rate per center was 78% (range, 39%-93%; 1st quartile, 61%) and per endoscopist was 75% (range, 0%-100%; 1st quartile, 52%).Limitations: Retrospective study, participation bias, and varying chronic pancreatitis prevalence.Conclusions: (1) EUS-FNA cytology was diagnostic of malignancy in 71% of solid pancreatic masses and (2) encloscopists with a final cytologic diagnosis rate of malignancy for EUS-FNA of solid masses that was less than 52% were in the lowest quartile and should evaluate reasons for their low yield.