Byrne M F, Gerke H, Mitchell R M, Stiffler H L, McGrath K, Branch M S, Baillie J, Jowell P S
Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA.
Endoscopy. 2004 Aug;36(8):715-9. doi: 10.1055/s-2004-825657.
It is still difficult to differentiate reliably between benign and malignant biliary tract lesions. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has added to the diagnostic power of EUS for other gastrointestinal tumors. A retrospective analysis of experience with FNA sampling of bile duct lesions was therefore carried out.
All EUS-FNA procedures for bile duct masses or strictures were analyzed at our tertiary referral center from May 2000 through October 2002. Data for EUS findings, the results of EUS-FNA, and tissue sampling at surgery were included. EUS-FNA procedures were carried out using a 22-gauge needle. An experienced cytopathologist was present during FNA in all but three cases. Clinical follow-up details were recorded when available for patients in whom a suitable diagnostic gold standard was not available for comparison.
A total of 35 patients underwent EUS-FNA of bile duct lesions during the study period. There were no complications. Data for EUS-FNA of bile duct masses or strictures and tissue obtained at surgery were available for 23 patients. If positive cytology at surgical pathology is taken as the gold standard, EUS-FNA has a diagnostic yield for cancer of 100 % (if atypia/inconclusive findings in the FNA sample are regarded as benign). Eleven patients had a definite malignancy on surgical pathology. Of these 11 patients, five had a finding of malignancy on EUS-FNA, giving a sensitivity of 45 % (if FNA cytology reported as atypia/inconclusive is regarded as benign). Twelve patients had findings of no malignancy from tissue obtained at surgery. Of these 12 patients, nine had benign pathology and three had atypia/inconclusive findings in the EUS-FNA sample (specificity of 100 % if atypia/inconclusive findings are considered benign). A further 12 patients did not have surgical specimens for comparison with EUS-FNA results. Four patients had definite findings of malignancy on EUS-FNA alone, and one patient had FNA findings suspicious for malignancy. Seven patients had negative or equivocal EUS-FNA results. These 12 patients are described but excluded from further analysis, as a gold standard was not available for comparison. However, clinical follow-up data were available for eight of these 12 patients, and in each case the follow-up findings were compatible with previous benign or malignant EUS-FNA findings.
The practice of EUS-FNA has improved the diagnostic yield of EUS. These results suggest that it is a safe and useful procedure for investigating biliary masses or strictures that have hitherto caused considerable diagnostic confusion, especially in patients with negative brush cytology findings. The possibility of false-negative findings remains, but core biopsy needles may improve the situation. The results of further studies are awaited.
目前仍难以可靠地区分良性和恶性胆道病变。内镜超声引导下细针穿刺抽吸术（EUS-FNA）增强了EUS对其他胃肠道肿瘤的诊断能力。因此，我们对胆管病变细针穿刺抽吸采样的经验进行了回顾性分析。
对2000年5月至2002年10月期间在我们的三级转诊中心进行的所有针对胆管肿块或狭窄的EUS-FNA操作进行分析。纳入了EUS检查结果、EUS-FNA结果以及手术组织采样的数据。EUS-FNA操作使用22号针进行。除3例病例外，其余FNA操作均有经验丰富的细胞病理学家在场。对于没有合适诊断金标准可供比较的患者，若有临床随访细节则予以记录。
在研究期间，共有35例患者接受了胆管病变的EUS-FNA检查。未发生并发症。23例患者有胆管肿块或狭窄的EUS-FNA数据以及手术获取的组织。若将手术病理的阳性细胞学结果作为金标准，EUS-FNA对癌症的诊断率为100%（若FNA样本中的非典型/不确定结果视为良性）。11例患者手术病理确诊为恶性肿瘤。在这11例患者中，5例EUS-FNA检查发现恶性肿瘤，敏感性为45%（若FNA细胞学报告为非典型/不确定视为良性）。12例患者手术获取的组织未发现恶性肿瘤。在这12例患者中，9例病理为良性，3例EUS-FNA样本有非典型/不确定结果（若将非典型/不确定结果视为良性，特异性为100%）。另有12例患者没有手术标本可与EUS-FNA结果进行比较。4例患者仅EUS-FNA检查有明确的恶性肿瘤发现，1例患者FNA检查结果怀疑为恶性肿瘤。7例患者EUS-FNA检查结果为阴性或不明确。这12例患者予以描述但排除在进一步分析之外，因为没有金标准可供比较。然而，这12例患者中有8例有临床随访数据，且每种情况下随访结果均与先前良性或恶性EUS-FNA检查结果相符。
EUS-FNA操作提高了EUS的诊断率。这些结果表明，对于迄今为止造成相当大诊断困惑的胆道肿块或狭窄，尤其是刷检细胞学结果为阴性的患者，EUS-FNA是一种安全且有用的检查方法。假阴性结果的可能性仍然存在，但粗针活检可能会改善这种情况。有待进一步研究的结果。
