Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration
Clinical impact of on-site cytopathology interpretation on endoscopic ultrasound-guided fine needle aspiration
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DOI：
10.1016/s0002-9270(03)00246-6
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发表时间：
2003-06-01
影响因子：
9.8
通讯作者：
Waxman, I
中科院分区：
文献类型：
--
作者：
Klapman, JB;Logrono, R;Waxman, I
目的：超声内镜引导下细针穿刺（EUS引导下FNA）正在成为诊断和分期GI和纵隔恶性肿瘤的首选方式。尽管专家主张对组织样本的充分性进行现场细胞病理学评估，但很少有数据支持这一主张。我们的目标是确定是否现场细胞病理学解释提高诊断率EUS引导FNA.METHODS：EUS引导FNA结果从两个大学医院中心进行了审查和比较。在中心1，由现场细胞病理学家进行EUS引导的FNA，评价了108例连续患者的结果。在2号中心，没有细胞病理学家，对87名连续患者的结果进行了审查。两个机构的所有手术均由一名内窥镜医生进行。细胞学诊断分类为恶性肿瘤阳性或阴性、可疑恶性肿瘤、非典型/不确定或不满意。重复程序的数量，针通过，药物使用，目标部位，年龄和性别进行了比较两个site.Results：患者在中心2年龄较大（p = 0.04），主要是女性（p = 0.03）。胰腺是中心2最常见的靶部位，而胸腹淋巴结是中心I最常见的靶部位（p = 0.0001）。中心1的患者更频繁地诊断为恶性肿瘤阳性或阴性（p = 0.001），并且不太可能有不满意的标本（p = 0.035）或重复程序，尽管后者不显著（p = 0.156）结论：现场细胞病理学解释提高了EUS引导下FNA的诊断率。EUS中心应分配资源以涵盖现场细胞病理学评价。(C)2003年，我胃肠病学。
OBJECTIVES: Endoscopic ultrasound-guided fine needle aspiration (EUS-guided FNA) is becoming a preferred modality for diagnosing and staging GI and mediastinal malignancies. Although experts advocate on-site cytopathology assessment for tissue sample adequacy, there are few data to support this claim. Our goal was to determine whether on-site cytopathology interpretation improves the diagnostic yield of EUS-guided FNA.METHODS: EUS-guided FNA results from two University hospital centers were reviewed and compared. At center 1, where EUS-guided FNA was performed with a cytopathologist on site, the results of 108 consecutive patients were evaluated. At center 2, where a cytopathologist is unavailable, the results of 87 consecutive patients were reviewed. One endoscopist performed all procedures at both institutions. Cytologic diagnoses were categorized as positive or negative for malignancy, suspicious for malignancy, atypical/indeterminate, or unsatisfactory. The number of repeat procedures, needle passes, medication use, target site, age, and sex were compared between the two sites.RESULTS: Patients at center 2 were older (p = 0.04) and predominantly female (p = 0.03). Pancreas was the most common target site at center 2, whereas thoraco-abdominal nodes were the most common at center I (p = 0.0001). Patients at center 1 had a diagnosis of positive or negative for malignancy more frequently (p = 0.001) and were less likely to have an unsatisfactory specimen (p = 0.035) or repeat procedure, although the latter was not significant (p = 0.156)CONCLUSION: On-site cytopathology interpretation improves the diagnostic yield of EUS-guided FNA. EUS centers should allocate resources to cover for on-site cytopathology evaluation. (C) 2003 by Am. Coll. of Gastroenterology.