Diagnosis of autoimmune pancreatitis by EUS-guided FNA using a 22-gauge needle: a prospective multicenter study
Diagnosis of autoimmune pancreatitis by EUS-guided FNA using a 22-gauge needle: a prospective multicenter study
复制标题
DOI：
10.1016/j.gie.2016.03.1511
复制
发表时间：
2016-11-01
影响因子：
7.7
通讯作者：
Shimosegawa, Tooru
中科院分区：
文献类型：
--
作者：
Kanno, Atsushi;Masamune, Atsushi;Shimosegawa, Tooru
背景和目的：组织病理学检查对于诊断自身免疫性胰腺炎（AIP）至关重要。然而，由于样本量不足，不建议使用 EUS 引导 FNA (EUS-FNA) 获得的标本用于组织病理学诊断。我们使用 22G 针评估了 EUS-FNA 对 AIP 诊断的疗效。方法：2013 年 2 月至 2014 年 3 月期间，78 名在胰实质和胰管中表现出 AIP 影像学特征的患者在 12 个机构接受了使用 22G 针的 EUS-FNA。结果：78 名患者中分别有 29 名（37.2%）、18 名（23.1%）和 15 名（19.2%）患者获得了含有 > 10、5 至 10 和 1 至 4 个高倍视野 (HPF) 的组织标本。 CD38和IgG4阳性浆细胞计数的平均值+/-标准差(SD)分别为23.2+/-18.8/HPF和5.1+/-6.7/HPF。 78 名患者中有 49 名 (62.8%) 检测到 SF，78 名患者中有 38 名 (48.7%) 检测到 OP。根据国际共识诊断标准 (ICDC)，32 名患者的组织病理学水平相当于 1 级，13 名患者的组织病理学水平相当于 2 级，17 名患者无法分类。因此，根据ICDC，78名患者中的45名（57.7%）可以诊断为淋巴浆细胞性硬化性胰腺炎。结论：通过EUS-FNA从约80%的患者中获得至少1个HPF的胰腺组织，近60%的患者被诊断为ICDC 2级或更高级别。我们的研究结果表明，使用 22G 针的 EUS-FNA 可能有助于 AIP 的组织病理学诊断。
Background and Aims: Histopathologic examination is critical for diagnosing autoimmune pancreatitis (AIP). However, specimens obtained using EUS-guided FNA (EUS-FNA) are not recommended for histopathologic diagnosis because of inadequate sample size volume. We evaluated EUS-FNA efficacy for AIP diagnosis using a 22G needle.Methods: Seventy-eight patients exhibiting the imaging characteristics indicative of AIP in the pancreatic parenchyma and pancreatic duct underwent EUS-FNA with a 22 G needle at 12 institutions between February 2013 and March 2014. Samples were evaluated for tissue sampling conditions, CD38- and IgG4-positive plasma cell counts, storiform fibrosis (SF), and obliterative phlebitis (OP).Results: Tissue specimens containing > 10, 5 to 10, and 1 to 4 high-power fields (HPFs) were obtained from 29 (37.2%), 18 (23.1%), and 15 (19.2%) of 78 patients, respectively. The mean +/- standard deviation (SD) CD38-and IgG4-positive plasma cell counts were 23.2 +/- 18.8/HPF and 5.1 +/- 6.7/HPF, respectively. SF was detected in 49 of 78 patients (62.8%) and OP in 38 of 78 patients (48.7%). According to the International Consensus Diagnostic Criteria (ICDC), histopathologic levels corresponded to level 1 in 32, level 2 in 13, and unclassifiable in 17 patients. Hence, 45 of 78 patients (57.7%) could be diagnosed with lymphoplasmacytic sclerosing pancreatitis according to ICDC.Conclusions: Pancreatic tissues with at least 1 HPF were obtained by EUS-FNA from approximately 80% of patients, and nearly 60% of patients were diagnosed with ICDC level 2 or higher. Our findings indicate that EUS-FNA with a 22G needle may be useful for the histopathologic diagnosis of AIP.