Sedlack Robert, Affi Aboud, Vazquez-Sequeiros Enrique, Norton Ian D, Clain Jonathan E, Wiersema Maurits J
Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Gastrointest Endosc. 2002 Oct;56(4):543-7. doi: 10.1067/mge.2002.128106.
Preoperative differentiation of benign and malignant/potentially malignant pancreatic cystic lesions is problematic. Data to support the role of EUS and EUS-guided fine-needle aspiration (EUS-FNA) are limited. This study assessed the sensitivity, specificity, and accuracy of EUS, cytopathology, and analysis of cyst fluid for pancreatic cystic lesions.
Retrospectively, 111 consecutive patients were identified (54 men, 57 women; mean age 59 years, range 18-79 years) who underwent EUS from July 1997 to September 2000 because of known or suspected pancreatic cystic lesions based on CT or transabdominal US. Thirty-four patients (16 men, 18 women; mean age 55 years, 25-79 years) who underwent surgery formed the basis for this analysis. EUS diagnosis was compared with surgical pathology. Selected patients underwent EUS-FNA to obtain specimens for cytopathologic analysis and for determination of carcinoembryonic antigen levels. Based on surgical pathology, cysts were classified as benign (simple cyst, pseudocyst, serous cystadenoma) or malignant/potentially malignant (mucinous cystadenoma, intraductal papillary mucinous tumor, cystic islet cell tumor, cystic adenocarcinoma).
EUS-FNA with cytopathologic assessment of cyst fluid was performed for 18 of the 34 patients; carcinoembryonic antigen level was determined in 11 cases. For EUS, cytopathology, and carcinoembryonic antigen, sensitivity was, respectively, 91%, (p = 0.01 vs. cytology), 27%, and 28%; specificity was, respectively, 60%, 100%, and 25%; and, accuracy was, respectively, 82%, 55%, and 27%. The sensitivity of EUS in all 13 patients with cystic islet cell tumor, intraductal papillary mucinous tumor, or cystic adenocarcinoma was 100%. Combining EUS, cytopathology, and carcinoembryonic antigen results did not improve accuracy. There were no complications related to the EUS or EUS-FNA.
EUS alone is sensitive and accurate in identifying malignant/potentially malignant pancreatic cystic lesions. EUS-FNA to obtain specimens for cytopathologic analysis and determination of carcinoembryonic antigen levels, although safe, does not enhance diagnostic yield.
术前鉴别胰腺囊性病变的良恶性/潜在恶性存在问题。支持内镜超声（EUS）及EUS引导下细针穿刺抽吸术（EUS-FNA）作用的数据有限。本研究评估了EUS、细胞病理学及囊液分析对胰腺囊性病变的敏感性、特异性和准确性。
回顾性分析1997年7月至2000年9月间连续111例患者（54例男性，57例女性；平均年龄59岁，范围18 - 79岁），这些患者因基于CT或经腹超声检查发现已知或疑似胰腺囊性病变而接受EUS检查。34例接受手术的患者（16例男性，18例女性；平均年龄55岁，25 - 79岁）构成了本分析的基础。将EUS诊断结果与手术病理结果进行比较。部分患者接受EUS-FNA以获取标本进行细胞病理学分析及测定癌胚抗原水平。根据手术病理，囊肿被分为良性（单纯囊肿、假性囊肿、浆液性囊腺瘤）或恶性/潜在恶性（黏液性囊腺瘤、导管内乳头状黏液性肿瘤、囊性胰岛细胞瘤、囊腺癌）。
34例患者中有18例接受了EUS-FNA并对囊液进行细胞病理学评估分析；11例测定了癌胚抗原水平。对于EUS、细胞病理学及癌胚抗原，敏感性分别为91%（与细胞学相比，p = 0.01）、27%和28%；特异性分别为60%、100%和25%；准确性分别为82% , 55%和27%。EUS对所有患有囊性胰岛细胞瘤、导管内乳头状黏液性肿瘤或囊腺癌的13例患者的敏感性为100%。联合EUS、细胞病理学及癌胚抗原结果并未提高准确性。未发生与EUS或EUS-FNA相关的并发症。
单独使用EUS在识别恶性/潜在恶性胰腺囊性病变方面敏感且准确。EUS-FNA获取标本进行细胞病理学分析及测定癌胚抗原水平，虽然安全，但并未提高诊断率。
