Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: Diagnostic accuracy and acute and 30-day complications
Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: Diagnostic accuracy and acute and 30-day complications
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DOI：
10.1016/s0002-9270(03)01699-x
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发表时间：
2003-12-01
影响因子：
9.8
通讯作者：
Wilcox, CM
中科院分区：
文献类型：
--
作者：
Eloubeidi, MA;Chen, VK;Wilcox, CM
目的：本研究的目的是评估内镜超声引导下细针穿刺活检（EUS-FNA）在疑似胰腺癌患者中的诊断准确性，并评估EUS-FNA.Methods相关的即刻、急性和30天并发症：对所有疑似胰腺癌患者进行前瞻性评估。一名胃肠病学家在细胞病理学家在场的情况下进行所有EUS-FNA。对所有患者的即刻并发症进行了评价。一名经验丰富的护士在手术后24-72小时和30天致电患者。最终诊断的分类参考标准包括：手术（n=48），临床或影像学随访（n=63），或死亡的疾病（n=47）。结果：共158例患者（平均年龄62.3岁）进行EUS-FNA在研究期间。平均肿瘤大小为32 × 26 mm。平均通过次数为3次（范围1 - 10次）。在这些患者中，44%的患者在EUS-FNA之前至少有一次组织诊断尝试失败。EUS-FNA诊断胰腺实性肿块的敏感性、特异性、PPV、NPV和准确性分别为84.3%、97%、99%、64%和84%。158例EUS-FNA中有10例（6.3%）发生了即刻自限性并发症。在24-72小时联系的90名患者中，78名患者（87%）有反应。在90例患者中，20例（22%）报告了至少一种症状，除3例病例（1例自限性急性胰腺炎和2例急诊室就诊，其中1例导致住院）外，所有症状均为轻微症状。在30天内，总共联系了83名患者，82%的患者有反应。没有额外的或持续的并发症reported.Conclusions：EUS-FNA是高度准确的，在确定可疑胰腺癌患者，特别是当其他方式已经失败。EUS-FNA后的严重并发症是罕见的，轻微并发症与上消化道内镜相似。似乎在1周时进行随访可以捕获与EUS-FNA相关的所有不良事件。
Objectives: The aims of this study were to evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with suspected pancreatic cancer, and to assess immediate, acute, and 30-day complications related to EUS-FNA.Methods: All patients with suspected pancreatic cancer were prospectively evaluated. A single gastroenterologist performed all EUS-FNAs in the presence of a cytopathologist. Immediate complications were evaluated in all patients. An experienced nurse called patients 24-72 h and 30 days after the procedure. Reference standard for the classification of the final diagnosis included: surgery (n=48), clinical or imaging follow-up (n=63), or death from the disease (n=47).Results: A total of 158 patients (mean age 62.3 yr) underwent EUS-FNA during the study period. The mean tumor size was 32 X 26 mm. The median number of passes was three (range one to 10). Of these patients, 44% had at least one failed attempt at tissue diagnosis before EUS-FNA. The sensitivity, specificity, PPV, NPV, and accuracy of EUS-FNA in solid pancreatic masses were 84.3%, 97%, 99%, 64%, and 84%, respectively. Immediate self-limited complications occurred in 10 of the 158 EUS-FNAs (6.3%). Of 90 patients contacted at 24-72 h, 78 patients (87%) responded. Of the 90 patients, 20 (22%) reported at least one symptom, all of which were minor except in three cases (one self-limited acute pancreatitis and two emergency room visits, one of which led to admission). In all, 83 patients were contacted at 30 days, and 82% responded. No additional or continued complications were reported.Conclusions: EUS-FNA is highly accurate in identifying patients with suspected pancreatic cancer, especially when other modalities have failed. Major complications after EUS-FNA are rare, and minor complications are similar to those reported for upper endoscopy. It seems that follow-up at 1 wk might capture all of the adverse events related to EUS-FNA.