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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超声内镜引导下疑似胰腺癌患者的细针抽吸活检：诊断准确性以及急性和 30 天并发症
DOI：
10.1111/j.1572-0241.2003.08666.x
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发表时间：
2003
影响因子：
9.8
通讯作者：
Mel C. Wilcox
中科院分区：
文献类型：
--
作者：
M. Eloubeidi;V. Chen;I. Eltoum;D. Jhala;D. Chhieng;N. Jhala;S. Vickers;Mel C. Wilcox
目的：本研究的目的是评估内镜超声引导下细针穿刺（EUS-FNA）对疑似胰腺癌患者的诊断准确性，并评估EUS-FNA相关的即时、急性和30天并发症。方法：对所有疑似胰腺癌患者进行前瞻性评价。在细胞病理学家在场的情况下，由一名胃肠病学家进行所有EUS-FNAs检查。对所有患者的即时并发症进行评估。一位经验丰富的护士在手术后24-72小时和30天给病人打电话。最终诊断分类的参考标准包括：手术（n = 48）、临床或影像学随访（n = 63）、疾病死亡（n = 47）。结果：共有158例患者（平均年龄62.3岁）在研究期间接受了EUS-FNA。肿瘤平均大小32 × 26 mm。通过次数的中位数是3次（范围从1到10）。在这些患者中，44%在EUS-FNA前至少有一次失败的组织诊断尝试。EUS-FNA对胰腺实性包块的敏感性、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%）发生了立即的自限性并发症。在24-72小时接触的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（1例自限性急性胰腺炎和2例急诊室就诊，其中1例入院）外，所有症状都很轻微。总共有83名患者在30天内接触，82%的患者有反应。没有其他或持续的并发症报道。结论：EUS-FNA在鉴别疑似胰腺癌患者方面具有很高的准确性，特别是当其他方法都失败时。EUS-FNA术后的主要并发症很少，轻微并发症与上内镜相似。1周的随访似乎可以捕捉到所有与EUS-FNA相关的不良事件。
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 × 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.