Frossard Jean Louis, Amouyal Paul, Amouyal Gilles, Palazzo Laurent, Amaris Juan, Soldan Manuela, Giostra Emiliano, Spahr Laurent, Hadengue Antoine, Fabre Monique
Division of Gastroenterology, Geneva University Hospital, Geneva, Switzerland.
Am J Gastroenterol. 2003 Jul;98(7):1516-24. doi: 10.1111/j.1572-0241.2003.07530.x.
Preoperative diagnosis of cystic lesions of the pancreas remains difficult despite improvement in imaging modalities and cystic fluid analysis. The aim of our study was to assess the performance of endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (FNA) in the diagnosis of pancreatic cystic lesions.
Data from a series of 127 consecutive patients with pancreatic cystic lesions were prospectively studied. EUS and EUS-guided FNA were performed in all patients, and cystic material was used for cytological and histological analysis as well as for biochemical and tumor markers analysis. Performance of EUS diagnosis, biochemical and tumor markers, and FNA diagnosis were compared with the final histological diagnosis obtained at surgery or postmortem examination. Sixty-seven patients underwent surgery and therefore constituted our study group.
EUS provided a tentative diagnosis in 113 cases (89%). Cytohistological FNA provided a diagnosis in 98 cases (77%). When the results of EUS and EUS-guided FNA were compared with the final diagnosis (67 cases), EUS correctly identified 49 cases (73%), whereas FNA correctly identified 65 cases (97%). Sensitivity, specificity, positive predictive value, and negative predictive value of EUS and EUS-guided FNA to indicate whether a lesion needed further surgery were 71% and 97%, 30% and 100%, 49% and 100%, and 40% and 95%, respectively. Carbohydrate antigen 19-9 > 50,000 U/ml had a 15% sensitivity and a 81% specificity to distinguish mucinous cysts from other cystic lesions, whereas it had a 86% sensitivity and a 85% specificity to distinguish cystadenocarcinoma from other cystic lesions.
EUS-guided FNA is a valuable tool in the preoperative diagnostic assessment of pancreatic cystic lesions.
尽管成像方式和囊液分析有所改进，但胰腺囊性病变的术前诊断仍然困难。我们研究的目的是评估内镜超声检查（EUS）和EUS引导下细针穿刺抽吸（FNA）在胰腺囊性病变诊断中的性能。
对连续127例胰腺囊性病变患者的数据进行前瞻性研究。所有患者均接受EUS和EUS引导下FNA检查，囊液用于细胞学和组织学分析以及生化和肿瘤标志物分析。将EUS诊断、生化和肿瘤标志物以及FNA诊断的性能与手术或尸检时获得的最终组织学诊断进行比较。67例患者接受了手术，因此构成了我们的研究组。
EUS在113例（89%）中提供了初步诊断。细胞组织学FNA在98例（77%）中提供了诊断。当将EUS和EUS引导下FNA的结果与最终诊断（67例）进行比较时，EUS正确识别了49例（73%），而FNA正确识别了65例（97%）。EUS和EUS引导下FNA用于指示病变是否需要进一步手术的敏感性、特异性、阳性预测值和阴性预测值分别为71%和97%、30%和100%、49%和100%、40%和95%。糖类抗原19-9>50,000 U/ml区分黏液性囊肿与其他囊性病变的敏感性为15%，特异性为81%，而区分囊腺癌与其他囊性病变的敏感性为86%，特异性为85%。
EUS引导下FNA是胰腺囊性病变术前诊断评估的有价值工具。
