Larghi Alberto, Verna Elizabeth C, Stavropoulos Stavros N, Rotterdam Heidrun, Lightdale Charles J, Stevens Peter D
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Gastrointest Endosc. 2004 Feb;59(2):185-90. doi: 10.1016/s0016-5107(03)02538-0.
A trucut needle biopsy device that can be used to obtain specimens from the pancreas and other perigastric organs under EUS guidance has been developed and successfully tested in animals. Moreover, EUS-guided trucut needle biopsy has been used safely in humans and appears to provide more accurate results than EUS-guided FNA. This study prospectively assessed the clinical utility of this new device in patients with solid pancreatic masses.
Twenty-three consecutive patients with radiologically detected solid pancreatic masses underwent EUS-guided trucut needle biopsy. Pancreatic malignancy detected by EUS-guided trucut needle biopsy was considered a definitive diagnosis. Further diagnostic procedures and clinical course were used to establish or exclude the presence of malignancy in all other patients.
Pancreatic tissue was obtained in 17 of the 23 patients (74%), including all patients in whom the transgastric approach was used. No acute or long-term complication was observed. Histopathologic evaluation revealed pancreatic cancer in 12 patients. CT-guided biopsy specimens were obtained in 4 of the 5 patients with a negative EUS-guided trucut needle biopsy result; two were positive for adenocarcinoma. Overall diagnostic accuracy was 61%. Subgroup analysis of the 16 patients in whom EUS-guided trucut needle biopsy was successful and who were available for follow-up revealed a diagnostic accuracy of 87.5%.
This prospective study demonstrates that EUS-guided trucut needle biopsy, when performed transgastrically, is safe and accurate in the evaluation of patients with solid pancreatic masses.
一种可在超声内镜（EUS）引导下从胰腺及其他胃周器官获取标本的切割针活检装置已研发成功，并在动物身上进行了成功测试。此外，EUS引导下的切割针活检已在人体中安全使用，且似乎比EUS引导下的细针穿刺抽吸活检（FNA）能提供更准确的结果。本研究前瞻性评估了这种新装置在实性胰腺肿块患者中的临床应用价值。
连续23例经放射学检查发现有实性胰腺肿块的患者接受了EUS引导下的切割针活检。EUS引导下切割针活检检测到的胰腺恶性肿瘤被视为确诊。所有其他患者通过进一步的诊断程序和临床病程来确定或排除恶性肿瘤的存在。
23例患者中有17例（74%）获取到了胰腺组织，包括所有采用经胃途径的患者。未观察到急性或长期并发症。组织病理学评估显示12例患者患有胰腺癌。5例EUS引导下切割针活检结果为阴性的患者中有4例获得了CT引导下的活检标本；其中2例腺癌呈阳性。总体诊断准确率为61%。对16例EUS引导下切割针活检成功且可进行随访的患者进行亚组分析，诊断准确率为87.5%。
这项前瞻性研究表明，经胃途径进行EUS引导下的切割针活检在评估实性胰腺肿块患者时是安全且准确的。
