Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic and peripancreatic lesions: is onsite cytopathology necessary?
Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic and peripancreatic lesions: is onsite cytopathology necessary?
复制标题
DOI：
10.1111/j.1477-2574.2010.00180.x
复制
发表时间：
2010-08-01
期刊：
影响因子：
2.9
通讯作者：
Mahon, Brinder S.
中科院分区：
文献类型：
--
作者：
Cherian, P. Thomas;Mohan, Prasoon;Mahon, Brinder S.
目的：据报道，内镜超声（EUS）细针穿刺（FNA）细胞学检查的诊断率中位数为78%（范围39-93%）。本研究的目的是描述一个单中心的经验，在诊断工作的固体胰腺和胰腺周围的肿块没有现场cytopathologist.Methods的好处：在一个连续的系列429 EUS检查进行了12个月的时间由一个单一的操作，108个非囊性胰腺或胆道病变。前瞻性地收集数据和FNA的准确性进行了评估，回顾性地使用手术或重复成像作为基准，在存在或不存在malignancy.Results：在108 FNAs，102（94%）是诊断，四个假阴性（FN）和两个是不典型的，被认为是模棱两可的。有78个胰腺病变，其中65个为真阳性（TP），11个为真阴性（TN），2个为FN，总体准确率为97%（76/78）。在9个壶腹周围病变中，2个为TP，6个为TN，1个为FN，总体准确率为8/9%（8/9）。EUS-FNA对胰腺和壶腹周围病变的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为96%、100%、100% [95%置信区间（CI）95-100%]、85%（95% CI 62-97%）和97%。胆管病变21处，其中TP 10处，TN 8处，不典型2处，FN 1处，总准确率为86%（18/21）。EUS-FNA诊断胆道病变的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为91%、100%、100%（95% CI 69-100%），91%结论：EUS-FNA对胰腺病变的诊断准确率为97%，PPV对三种病变类型的诊断准确率为100%;这些数字与文献中报道的最佳比率相当，尽管缺乏现场细胞病理学检查。这些发生率可能是大量实践、专用超声内镜和细胞病理学的直接结果。这些结果表明，在后勤问题使得不可能在内窥镜检查室中保持细胞病理学家的地方，可以实现高准确率。此外，我们的结果有助于EUS-FNA在壶腹周围和胆道病变中有效性的有限的集体全球经验。
Objectives: The reported median diagnostic yield from endoscopic ultrasound (EUS) fine-needle aspiration (FNA) cytology is 78% (range 39-93%). The aim of this study is to describe a single-centre experience in the diagnostic work-up of solid pancreatic and peripancreatic masses without the benefit of an onsite cytopathologist.Methods: In a consecutive series of 429 EUS examinations performed over a 12-month period by a single operator, 108 were on non-cystic pancreatic or biliary lesions. Data were collected prospectively and the accuracy of FNA was assessed retrospectively using either surgery or repeat imaging as the benchmark in the presence or absence of malignancy.Results: Of the 108 FNAs, 102 (94%) were diagnostic, four were falsely negative (FN) and two were atypical and considered equivocal. There were 78 pancreatic lesions, of which 65 were true positives (TP), 11 true negatives (TN) and two FN, giving an overall accuracy of 97% (76/78). Of nine periampullary lesions, two were TP, six were TN and one was FN, giving an overall accuracy of 89% (8/9). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of EUS-FNA for pancreatic and periampullary lesions combined were 96%, 100%, 100% [95% confidence interval (CI) 95-100%], 85% (95% CI 62-97%) and 97%, respectively. There were 21 bile duct lesions, of which 10 were TP, eight TN, two atypical and one FN, giving an overall accuracy of 86% (18/21). The sensitivity, specificity, PPV, NPV and accuracy of EUS-FNA for biliary lesions were 91%, 100%, 100% (95% CI 69-100%), 91% (95% CI 59-100%) and 95%, respectively.Conclusions: The diagnostic accuracy of EUS-FNA for pancreatic lesions in our series was 97% and the PPV for the three subgroups of lesion type was 100%; these figures are comparable with the best rates reported in the literature, despite the absence of onsite cytopathology. These rates are potentially a direct result of high-volume practice, dedicated endosonography and cytopathology. These results show that it is possible to achieve high rates of accuracy in places where logistical issues make it impossible to maintain a cytopathologist in the endoscopy suite. In addition, our results contribute to the limited, collective global experience on the effectiveness of EUS-FNA in periampullary and biliary lesions.