Erturk Sukru Mehmet, Mortelé Koenraad J, Tuncali Kemal, Saltzman John R, Lao Roger, Silverman Stuart G
Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.
AJR Am J Roentgenol. 2006 Dec;187(6):1531-5. doi: 10.2214/AJR.05.1657.
Imaging-guided biopsies of solid pancreatic masses are performed with either CT or endoscopic sonography at our institution. We compared test characteristics of fine-needle aspiration biopsies guided using CT with those guided using endoscopic sonography and secondarily evaluated for an effect of mass size.
Of 70 solid pancreatic masses, 43 (mean size, 4.4 cm; range, 1.5-10.3 cm) underwent fine-needle (20- to 22-gauge) aspiration biopsy with CT guidance and 27 (mean size, 2.3 cm; range, 1.0-5.0 cm) underwent fine-needle (22-gauge) aspiration biopsy with endoscopic sonography guidance. The diagnostic rate, sensitivity, and negative predictive value (NPV) for each technique were compared using Fisher's exact test before and after stratifying masses by size as small (< or = 3 cm) or large (> 3 cm).
The overall diagnostic rate, sensitivity, and NPV of fine-needle aspiration biopsies guided using CT (97.7%, 94.9%, and 60%, respectively) were not significantly different from those guided using endoscopic sonography (88.9%, 85%, and 57.1%, respectively). Among small masses, the diagnostic rate and sensitivity for biopsies guided using CT (100% and 100%, respectively) were not significantly different from those for biopsies guided using endoscopic sonography (90.9% and 93.8%, respectively). Among large masses, the diagnostic rate and sensitivity (96.6% and 92.3%, respectively) for biopsies guided using CT were not significantly different from those for biopsies guided using endoscopic sonography (83.3% and 50%, respectively).
When biopsying solid pancreatic masses with fine needles, procedures guided with CT and those guided with endoscopic sonography have similar test characteristics regardless of mass size.
在我们机构中，实性胰腺肿块的影像引导活检采用CT或内镜超声进行。我们比较了CT引导下细针穿刺活检与内镜超声引导下细针穿刺活检的检测特征，并其次评估了肿块大小的影响。
70例实性胰腺肿块中，43例（平均大小4.4 cm；范围1.5 - 10.3 cm）在CT引导下进行细针（20 - 22号）穿刺活检，27例（平均大小2.3 cm；范围1.0 - 5.0 cm）在内镜超声引导下进行细针（22号）穿刺活检。在按大小将肿块分为小（≤3 cm）或大（> 3 cm）两类前后，使用Fisher精确检验比较每种技术的诊断率、敏感性和阴性预测值（NPV）。
CT引导下细针穿刺活检的总体诊断率、敏感性和NPV分别为97.7%、94.9%和60%，与内镜超声引导下的（分别为88.9%、85%和57.1%）无显著差异。在小肿块中，CT引导下活检的诊断率和敏感性（分别为100%和100%）与内镜超声引导下活检的（分别为90.9%和93.8%）无显著差异。在大肿块中，CT引导下活检的诊断率和敏感性（分别为96.6%和92.3%）与内镜超声引导下活检的（分别为83.3%和50%）无显著差异。
在用细针活检实性胰腺肿块时，无论肿块大小，CT引导的操作和内镜超声引导的操作具有相似的检测特征。
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