Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists
Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists
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DOI：
10.1007/s00535-009-0001-6
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发表时间：
2009-04-01
影响因子：
6.3
通讯作者：
Obara, Katsutoshi
中科院分区：
文献类型：
--
作者：
Hikichi, Takuto;Irisawa, Atsushi;Obara, Katsutoshi
据报道，内镜超声引导下细针穿刺（EUS-FNA）结合快速现场评价（ROSE）可提供比不进行此类评价的EUS-FNA更准确的诊断。然而，即使是内窥镜超声医师也可以评估ROSE样本充足性。本研究的目的是评价EUS-FNA与ROSE的内镜超声医师相比，ROSE的细胞病理学家诊断胰腺实性肿块的准确性。在2001年9月至2005年10月期间，73例EUS-FNA程序与最终诊断，38例程序后，介绍了ROSE内镜超声医师（2001年9月至2003年9月，第1阶段）和细胞病理学家引入ROSE后的35例手术（2003年10月至2005年10月，第2阶段）。用Diff-Quik染色剂对标本进行染色并进行评估。当现场评估员（超声内镜医师或细胞病理学家）指出细胞样本量足够时，停止程序。结果以95%置信限表示。第1和2阶段的平均进针次数分别为4.0 +/- A 1.6和3.4 +/- A 1.5（P = 0.06）。周期1和周期2的标本采集率分别为97.4%和97.1%（P = 0.51）。恶性和良性的敏感性、特异性、阳性预测值、阴性预测值和准确性在第1阶段分别为92.9%、100%、100%、83.3%和94.7%，在第2阶段分别为93.1%、100%、100%、75.0%和94.3（P = 0.97、P = 1.0、P = 1.0、P = 0.65、P = 0.93）。为了准确诊断，在没有细胞病理学家的情况下，内镜超声医师应在EUS-FNA过程中进行ROSE。
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with rapid on-site evaluation (ROSE) has been reported to provide a more accurate diagnosis than EUS-FNA without such evaluation. However, even endosonographers can evaluate ROSE regarding sample adequacy. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers compared to ROSE by cytopathologists in patients with solid pancreatic masses.Between September 2001 and October 2005, of the 73 EUS-FNA procedures with the final diagnoses, 38 procedures after the introduction of ROSE by endosonographers (September 2001-September 2003, period 1), and 35 procedures after the introduction of ROSE by cytopathologists (October 2003-October 2005, period 2) were included. The specimens were stained with Diff-Quik stain and assessed. When the on-site assessors (endosonographers or cytopathologists) indicated that the amounts of cell samples were adequate, the procedure was stopped.Results are presented with 95% confidence limits. The average numbers of needle passes were 4.0 +/- A 1.6 and 3.4 +/- A 1.5 in periods 1 and 2, respectively (P = 0.06). The specimen collection rates were 97.4 and 97.1% in periods 1 and 2, respectively (P = 0.51). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy and benign were 92.9, 100, 100, 83.3, and 94.7%, respectively, in period 1, and 93.1, 100, 100, 75.0, and 94.3%, respectively, in period 2 (P = 0.97, P = 1.0, P = 1.0, P = 0.65, P = 0.93, respectively). No complications were seen.For accurate diagnosis, ROSE should be performed during EUS-FNA by the endosonographer, if no cytopathologist is available.