Eloubeidi Mohamad A, Varadarajulu Shyam, Desai Shilpa, Shirley Rhett, Heslin Martin J, Mehra Mohit, Arnoletti Juan P, Eltoum Isam, Wilcox Charles M, Vickers Selwyn M
Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama, Birmingham, Alabama, USA.
J Gastrointest Surg. 2007 Jul;11(7):813-9. doi: 10.1007/s11605-007-0151-x.
Whether tissue diagnosis is required in the preoperative evaluation of patients with suspected pancreatic cancer remains controversial. We prospectively evaluated the accuracy, safety, and potential impact on surgical intervention of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the preoperative evaluation of suspected pancreatic cancer.
All patients who underwent EUS-FNA at our institution (n = 547) over a 4.5-year period were enrolled. Patients underwent surgical exploration and resection based on their comorbidity status, evidence of resectability based on spiral computed tomography (CT) and EUS imaging reviewed in a multidisciplinary approach.
Of 547 patients enrolled (median age 64 years, 60% male), 49% presented with obstructive jaundice. The operating characteristics of EUS-FNA of solid pancreatic masses were: sensitivity 95% (95% CI: 93.2-95.4), specificity 92% (95% CI: 86.6-95.7), positive predictive value 98% (95% CI: 97-99), negative predictive value 80% (95% CI: 74.9-82.7). The overall accuracy of EUS-FNA was 94.1% (95% CI: 92.0-94). Of the 414 true positive patients by EUS-FNA, 138 (33%) were explored. Of patients deemed operable by combined imaging, 42% had surgical resection. Eighty-two percent of true positive patients were ultimately found inoperable and received palliative therapy or chemotherapy. Of the 94 patients with true negative cytology based on extended follow-up, only 7 (7%) underwent surgical resection. Of those with false negative diagnoses (n = 24), 5 patients underwent exploration/resection based on detection of mass lesions by EUS. The remaining patients had unresectable disease. Mild self-limiting pancreatitis occurred in (0.91%).
EUS-FNA is a safe and highly accurate method for tissue diagnosis in suspected pancreatic cancer. This approach allows for preoperative counseling of patients, minimizing surgeon's operative time in cases of unresectable disease, and avoids surgical biopsies in the majority of patients with inoperable disease. In addition, it allows for conservative management of patients with benign biopsies. We still, however, recommend exploration of patients with clinical scenario suspicious for pancreatic cancer, a mass found on EUS or CT, but inconclusive or negative cytology.
在疑似胰腺癌患者的术前评估中是否需要进行组织诊断仍存在争议。我们前瞻性地评估了内镜超声引导下细针穿刺活检（EUS-FNA）在疑似胰腺癌术前评估中的准确性、安全性以及对手术干预的潜在影响。
纳入在我们机构4.5年内接受EUS-FNA的所有患者（n = 547）。患者根据其合并症状态、基于螺旋计算机断层扫描（CT）和EUS成像以多学科方法评估的可切除性证据接受手术探查和切除。
在纳入的547例患者（中位年龄64岁，60%为男性）中，49%出现梗阻性黄疸。实性胰腺肿块EUS-FNA的操作特征为：敏感性95%（95%CI：93.2 - 95.4），特异性92%（95%CI：86.6 - 95.7），阳性预测值98%（95%CI：97 - 99），阴性预测值80%（95%CI：74.9 - 82.7）。EUS-FNA的总体准确率为94.1%（95%CI：92.0 - 94）。在EUS-FNA检查为真阳性的414例患者中，138例（33%）接受了探查。在综合影像学检查认为可手术的患者中，42%进行了手术切除。最终发现82%的真阳性患者无法手术，接受了姑息治疗或化疗。在94例经延长随访细胞学检查为真阴性的患者中，仅7例（7%）接受了手术切除。在那些诊断为假阴性的24例患者中，5例基于EUS发现的肿块病变接受了探查/切除。其余患者患有不可切除的疾病。轻度自限性胰腺炎的发生率为（0.91%）。
EUS-FNA是一种用于疑似胰腺癌组织诊断的安全且高度准确的方法。这种方法可为患者提供术前咨询，在疾病不可切除的情况下最大限度地减少外科医生的手术时间，并避免大多数无法手术的患者进行手术活检。此外，它允许对活检为良性的患者进行保守治疗。然而，我们仍然建议对临床情况可疑为胰腺癌、在EUS或CT上发现肿块但细胞学检查不确定或为阴性的患者进行探查。
