Storch Ian, Jorda Merce, Thurer Richard, Raez Luis, Rocha-Lima Caio, Vernon Stephen, Ribeiro Afonso
Division of Gastroenterology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida 33101, USA.
Gastrointest Endosc. 2006 Oct;64(4):505-11. doi: 10.1016/j.gie.2006.02.056. Epub 2006 Jun 6.
Endoscopic ultrasonographically guided fine-needle aspiration (EUS-FNA) is a safe and accurate method for obtaining diagnostic material from lesions within and immediately adjacent to the upper GI tract.
To determine whether EUS Trucut biopsy (EUS-TCB) (Quickcore, Wilson-Cook, Winstom Salem, NC) can increase the accuracy of EUS-guided tissue sampling when combined with FNA when no cytopathologist is present.
Retrospective case review.
University-based referral practice.
All patients who had lesions that were accessible through the esophagus or stomach and that were greater than 20 mm and amenable to Trucut biopsy were included.
A total of 41 patients underwent both EUS-FNA and TCB with a separate pathologist evaluating each specimen.
The diagnostic performance of FNA, TCB, and its combination were compared.
The overall accuracy in our series was as follows: FNA, 76%; TCB, 76% (P not significant); and combination of FNA and TCB, 95% (P = .007). In the 26 patients with malignant diagnoses, the accuracy of combination was 100% versus 77% for FNA (P = .03). The median number of passes with the FNA and TCB was 4.4 (range 2-8) and 2.8 (range 2-5), respectively. One patient in the series had fever and chest pain after EUS biopsy.
Retrospective study.
In our series EUS-TCB accuracy was equal to FNA when no on-site cytopathologist is present. TCB was helpful in the diagnosis of pancreatic masses, gastric submucosal lesions, lymphoma, and necrotic tumors. A 100% accuracy of FNA + TCB was seen in patients with malignant diseases and in patients who had failed or been refused biopsy by other modalities in the past. More data are needed before the exact role of TCB in the absence of on-site cytopathology can be accurately defined.
内镜超声引导下细针穿刺抽吸术（EUS-FNA）是一种从胃肠道上段及其紧邻病变获取诊断材料的安全、准确的方法。
确定在没有细胞病理学家在场时，EUS Trucut活检（EUS-TCB，Quickcore，Wilson-Cook，北卡罗来纳州温斯顿塞勒姆）与FNA联合使用时能否提高EUS引导下组织采样的准确性。
回顾性病例分析。
大学附属医院转诊机构。
纳入所有经食管或胃可触及、直径大于20mm且适合Trucut活检的病变患者。
41例患者接受了EUS-FNA和TCB，由不同的病理学家评估每个标本。
比较FNA、TCB及其联合使用的诊断性能。
我们系列研究中的总体准确率如下：FNA为76%；TCB为76%（P无统计学意义）；FNA与TCB联合为95%（P = 0.007）。在26例诊断为恶性病变的患者中，联合使用的准确率为100%，而FNA为77%（P = 0.03）。FNA和TCB的穿刺次数中位数分别为4.4次（范围2 - 8次）和2.8次（范围2 - 5次）。该系列中有1例患者在EUS活检后出现发热和胸痛。
回顾性研究。
在我们的系列研究中，当没有现场细胞病理学家时，EUS-TCB的准确率与FNA相当。TCB有助于胰腺肿块、胃黏膜下病变、淋巴瘤和坏死性肿瘤的诊断。在患有恶性疾病以及过去其他活检方式失败或被拒绝的患者中，FNA + TCB的准确率为100%。在没有现场细胞病理学检查的情况下，需要更多数据才能准确界定TCB的确切作用。
