Săftoiu Adrian, Vilmann Peter, Guldhammer Skov Birgit, Georgescu Claudia Valentina
Department of Gastroenterology, University of Medicine and Pharmacy, Craiova, Romania.
Scand J Gastroenterol. 2007 Jan;42(1):117-25. doi: 10.1080/00365520600789800.
Endoscopic ultrasound (EUS)-guided Trucut biopsy (EUS-TCB) has recently emerged as a method that seeks to overcome the limitations of EUS-guided fine needle aspiration (EUS-FNA) by providing a core-tissue specimen needed to increase the yield and accuracy of the diagnosis. The aim of our study was to evaluate whether EUS-TCB adds any information to EUS-FNA in selected patients and to assess the diagnostic yield, overall accuracy and complications of EUS-TCB as compared with EUS-FNA.
The study prospectively included 30 patients who had undergone both procedures.
The yield of adequate tissue harvesting was similar for EUS-FNA and EUS-TCB (96.4% versus 89.3%, p=NS), with the same number of passes done. The diagnostic accuracy of EUS-FNA was also similar to that of EUS-TCB for the diagnosis of malignant mediastinal masses (73.7% versus 68.4%, p=NS). However, the accuracy for obtaining a specific diagnosis was significantly lower for EUS-FNA compared with EUS-TCB (5.3% and 68.4%, p<0.005). EUS-TCB did not appear to help as a rescue procedure in mediastinal tumours, after a false negative result of EUS-FNA. All cases of submucosal tumours were correctly classified by EUS-TCB as gastrointestinal stromal cell tumours (GISTs) or leiomyomas, while EUS-FNA raised only a suspicion of mesenchymal tumour.
EUS-TCB was certainly useful when immunohistochemistry was needed, for example in submucosal tumours and lymphoma, as well as to confirm and characterize the primary or metastatic origin of mediastinal masses. The information provided by EUS-FNA and EUS-TCB is complementary, especially in selected cases where a complete histological diagnosis has an important impact on the clinical management.
内镜超声（EUS）引导下 Trucut 活检（EUS-TCB）最近已成为一种试图克服 EUS 引导下细针穿刺抽吸（EUS-FNA）局限性的方法，它可提供增加诊断的产量和准确性所需的核心组织标本。我们研究的目的是评估 EUS-TCB 在特定患者中是否能为 EUS-FNA 增添任何信息，并评估与 EUS-FNA 相比，EUS-TCB 的诊断产量、总体准确性及并发症情况。
该研究前瞻性纳入了 30 例接受了这两种操作的患者。
EUS-FNA 和 EUS-TCB 的足够组织获取产量相似（96.4%对 89.3%，p=无显著差异），穿刺次数相同。EUS-FNA 对恶性纵隔肿块诊断的准确性也与 EUS-TCB 相似（73.7%对 68.4%，p=无显著差异）。然而，与 EUS-TCB 相比，EUS-FNA 获取特定诊断的准确性显著更低（5.3%和 68.4%，p<0.005）。在 EUS-FNA 出现假阴性结果后，EUS-TCB 在纵隔肿瘤中似乎无助于作为补救程序。所有黏膜下肿瘤病例经 EUS-TCB 均正确分类为胃肠道间质细胞瘤（GISTs）或平滑肌瘤，而 EUS-FNA 仅引起对间叶性肿瘤的怀疑。
当需要免疫组化时，例如在黏膜下肿瘤和淋巴瘤中，以及用于确认和表征纵隔肿块的原发或转移来源时，EUS-TCB 肯定是有用的。EUS-FNA 和 EUS-TCB 提供的信息是互补的，特别是在某些完整组织学诊断对临床管理有重要影响的特定病例中。
