DeWitt John, LeBlanc Julia, McHenry Lee, Ciaccia Dan, Imperiale Tom, Chappo John, Cramer Harvey, McGreevy Kathy, Chriswell Melissa, Sherman Stuart
Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
Am J Gastroenterol. 2003 Sep;98(9):1976-81. doi: 10.1111/j.1572-0241.2003.07638.x.
The aim of this study was to report the sensitivity, cytological diagnoses, endoscopic ultrasound (EUS) features, complications, clinical impact, and long term follow-up of a large single-center experience with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of benign and malignant solid liver lesions.
A database of cytologic specimens from EUS-FNA was reviewed to identify all hepatic lesions aspirated between January, 1997, and July, 2002. Procedural indications, prior radiographic data, patient demographics, EUS examination results, complications, and follow-up data were obtained and recorded.
EUS-FNA of 77 liver lesions in 77 patients was performed without complications. Of these 77 lesions, 45 (58%) were diagnostic for malignancy, 25 (33%) were benign, and seven (9%) were nondiagnostic. A total of 22 lesions were confirmed as negative for malignancy by follow-up (mean 762 days, range 512-1556 days) or intraoperative examination; however, seven lesions could not be classified as benign or malignant. Depending on the status of the seven unclassified lesions, sensitivity of EUS-FNA for the diagnosis of malignancy ranged from 82 to 94%. When compared with benign lesions, EUS features predictive of malignant hepatic masses were the presence of regular outer margins (60% vs 27%; p = 0.02) and the detection of two or more lesions (38% vs 9%; p = 0.03). Of the 42 patients with malignancy identified by EUS-FNA and other available imaging records, EUS detected the malignancy in 41% of patients with previously negative examinations. For the 45 subjects with cytology positive for malignancy, EUS-FNA changed management in 86% of subjects.
EUS-FNA of the liver is a safe and sensitive procedure that can have a significant impact on patient management. Prospective studies comparing the accuracy and complication rate of EUS-FNA and percutaneous fine needle aspiration (P-FNA) for the diagnosis of liver tumors are needed.
本研究旨在报告在一个大型单中心中，对良性和恶性肝脏实性病变进行内镜超声引导下细针穿刺抽吸术（EUS-FNA）的敏感性、细胞学诊断、内镜超声（EUS）特征、并发症、临床影响及长期随访情况。
回顾EUS-FNA的细胞学标本数据库，以确定1997年1月至2002年7月期间所有经抽吸的肝脏病变。获取并记录操作指征、既往影像学数据、患者人口统计学资料、EUS检查结果、并发症及随访数据。
对77例患者的77个肝脏病变进行了EUS-FNA，无并发症发生。在这77个病变中，45个（58%）诊断为恶性，25个（33%）为良性，7个（9%）诊断不明确。共有22个病变经随访（平均762天，范围512 - 1556天）或术中检查证实为恶性阴性；然而，7个病变无法归类为良性或恶性。根据这7个未分类病变的情况，EUS-FNA诊断恶性病变的敏感性为82%至94%。与良性病变相比，预测恶性肝脏肿块的EUS特征为边缘规则（60%对27%；p = 0.02）以及检测到两个或更多病变（38%对9%；p = 0.03）。在经EUS-FNA及其他可用影像学记录确诊为恶性的42例患者中，EUS在41%先前检查为阴性的患者中检测到了恶性病变。对于45例细胞学检查为恶性阳性的受试者，EUS-FNA改变了86%受试者的治疗方案。
肝脏EUS-FNA是一种安全且敏感的操作方法，对患者的治疗管理可产生重大影响。需要进行前瞻性研究来比较EUS-FNA与经皮细针穿刺抽吸术（P-FNA）在诊断肝脏肿瘤方面的准确性和并发症发生率。
