Wallace M B, Kennedy T, Durkalski V, Eloubeidi M A, Etamad R, Matsuda K, Lewin D, Van Velse A, Hennesey W, Hawes R H, Hoffman B J
Division of Gastroenterology and Hepatology, Digestive Disease Center, Medical University of South Carolina, 96 Jonathan Lucas St., Charleston, SC 29425, USA.
Gastrointest Endosc. 2001 Oct;54(4):441-7. doi: 10.1067/mge.2001.117764.
EUS-guided fine needle aspiration (EUS-FNA) is a highly accurate method of detecting malignant lymphadenopathy. The optimal methods for performing EUS-FNA to maximize sensitivity and to minimize the number of needle passes necessary are unknown. This is a report of the results of a prospective randomized controlled trial to determine the effect of suction, the site of FNA (edge or center of lymph node), and the method of preparation of cytologic specimens on accuracy, number of needle passes needed, and specimen quality.
Consecutive patients with lymphadenopathy detected by EUS underwent FNA. Each lymph node was sampled with or without suction and from the edge or center in a 2 x 2 factorial design. The samples were expressed onto slides for cytology, and the residual material in the needle was analyzed by the cytospin-cellblock technique. Each aspirate was individually characterized for a diagnosis of malignancy, cellularity, and bloodiness.
Forty-three patients with a total of 46 lymph nodes were evaluated. The final lymph node diagnosis was benign in 22 (48%), "suspicious for malignancy" in 6 (13%), and malignant in 18 (39%). The use of suction was associated with an increase in the cellularity of the specimen, but did not improve the likelihood of obtaining a correct diagnosis (OR 1.52: 95% CI [0.81, 2.85]). Samples obtained with suction were of worse quality because of excessive bloodiness (OR 4.7: 95% CI [1.99, 11.24]). Aspiration from the edge of the lymph node (compared with the center) did not increase the likelihood of a correct diagnosis (OR 1.16: 95% CI [0.42, 3.21]). For 78% of malignant lymph nodes, the correct diagnosis was obtained on the first needle pass and for 100% by the third pass. Cytospin-cellblock methods did not add any additional diagnostic information compared with direct smear cytology.
The traditional method of applying suction during EUS-FNA does not improve diagnostic accuracy and worsens specimen bloodiness compared with FNA without suction. The site of FNA within the lymph node does not affect accuracy. When EUS-FNA is necessary, our recommendation is up to 3 FNAs without suction from the most convenient and safe location within abnormal-appearing lymph nodes.
超声内镜引导下细针穿刺抽吸术（EUS-FNA）是检测恶性淋巴结病的一种高度准确的方法。目前尚不清楚进行EUS-FNA以最大化敏感性并最小化所需穿刺针数的最佳方法。本文报告了一项前瞻性随机对照试验的结果，以确定抽吸、FNA部位（淋巴结边缘或中心）以及细胞学标本制备方法对准确性、所需穿刺针数和标本质量的影响。
对经EUS检测出淋巴结病的连续患者进行FNA。采用2×2析因设计，对每个淋巴结进行有或无抽吸以及从边缘或中心取样。将样本涂在载玻片上进行细胞学检查，并用细胞离心涂片-细胞块技术分析针内残留物质。对每份抽吸物的恶性诊断、细胞数量和血性分别进行特征描述。
共评估了43例患者的46个淋巴结。最终淋巴结诊断为良性的有22个（48%），“可疑恶性”的有6个（13%），恶性的有18个（39%）。使用抽吸与标本细胞数量增加相关，但并未提高获得正确诊断的可能性（比值比1.52：95%可信区间[0.81, 2.85]）。由于血性过多，使用抽吸获得的样本质量较差（比值比4.7：95%可信区间[1.99, 11.24]）。从淋巴结边缘（与中心相比）抽吸并未增加正确诊断的可能性（比值比1.16：95%可信区间[0.42, 3.21]）。对于78%的恶性淋巴结，首次穿刺即可获得正确诊断，第三次穿刺时100%可获得正确诊断。与直接涂片细胞学相比，细胞离心涂片-细胞块方法并未增加任何额外的诊断信息。
与无抽吸的FNA相比，EUS-FNA期间传统的抽吸方法并未提高诊断准确性，反而使标本血性增加。在淋巴结内进行FNA的部位不影响准确性。当需要进行EUS-FNA时，我们的建议是从外观异常的淋巴结内最方便和安全的位置进行最多3次无抽吸的FNA。
