Technical Advances in Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition for Pancreatic Cancers: How Can We Get the Best Results with EUS-Guided Fine Needle Aspiration?
Technical Advances in Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition for Pancreatic Cancers: How Can We Get the Best Results with EUS-Guided Fine Needle Aspiration?
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DOI：
10.5946/ce.2013.46.5.552
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发表时间：
2013-09
影响因子：
2.5
通讯作者：
Kahaleh M
中科院分区：
文献类型：
--
作者：
Kedia P;Gaidhane M;Kahaleh M
内窥镜超声引导下细针抽吸(EUS-FNA)是诊断胰腺实性病变中胰腺癌最有效、创伤最小的方法之一，其诊断准确率高于囊性肿瘤。EUS-FNA已被证明可以检测到小于3 mm的肿瘤，因为高空间分辨率允许检测非常小的病变和血管侵犯，特别是在胰头和颈部，这在横断面计算机断层扫描中可能无法检测到。此外，在不能切除的肿瘤患者的内窥镜下获取组织时，这种微创手术通常是理想的。虽然EUS-FNA已越来越多地被用作一种诊断工具，但大多数研究都集中在所有胰腺原发实质性病变，包括淋巴瘤和胰腺神经内分泌肿瘤，而很少有研究仅研究EUS-FNA对胰腺导管癌的诊断价值。与任何可能包含多种实践和方法的新的和先进的内窥镜手术一样，内窥镜医生已经采用了不同的技术来改进组织获取实践和提高诊断准确性。在这篇文章中，我们回顾了迄今为止的文献，并讨论了目前实用的EUS-FNA技术，包括适应症、技术细节、设备、患者选择和诊断准确性。
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is one of the least invasive and most effective modality in diagnosing pancreatic adenocarcinoma in solid pancreatic lesions, with a higher diagnostic accuracy than cystic tumors. EUS-FNA has been shown to detect tumors less than 3 mm, due to high spatial resolution allowing the detection of very small lesions and vascular invasion, particularly in the pancreatic head and neck, which may not be detected on transverse computed tomography. Furthermore, this minimally invasive procedure is often ideal in the endoscopic procurement of tissue in patients with unresectable tumors. While EUS-FNA has been increasingly used as a diagnostic tool, most studies have collectively looked at all primary pancreatic solid lesions, including lymphomas and pancreatic neuroendocrine neoplasms, whereas very few studies have examined the diagnostic utility of EUS-FNA of pancreatic ductal carcinoma only. As with any novel and advanced endoscopic procedure that may incorporate several practices and approaches, endoscopists have adopted diverse techniques to improve the tissue procurement practice and increase diagnostic accuracy. In this article, we present a review of literature to date and discuss currently practiced EUS-FNA technique, including indications, technical details, equipment, patient selection, and diagnostic accuracy.