Fisher Leon, Segarajasingam Dev Shankar, Stewart Colin, Deboer W Bastiaan, Yusoff Ian Fuad
Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Australia.
J Gastroenterol Hepatol. 2009 Jan;24(1):90-6. doi: 10.1111/j.1440-1746.2008.05569.x.
We report our single-centre experience with endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of solid pancreatic lesions with regard to clinical utility, diagnostic accuracy and safety.
We prospectively reviewed data on 100 consecutive EUS-FNA procedures performed in 93 patients (54 men, mean age 60.6 +/- 12.9 years) for evaluation of solid pancreatic lesions. Final diagnosis was based on a composite standard: histologic evidence at surgery, or non-equivocal malignant cytology on FNA and follow-up. The operating characteristics of EUS-FNA were determined.
The location of the lesions was pancreatic head in 73% of cases, the body in 20% and the tail in 7%. Mean lesion size was 35.1 +/- 12.9 mm. The final diagnosis revealed malignancy in 87 cases, including adenocarcinomas (80.5%), neuroendocrine tumours (11.5%), lymphomas (3.4%) and other types (4.6%). The FNA findings were: 82% interpreted as malignant cytology, 1% as suspicious for neoplasia, 1% as atypical, 7% as benign process and 9% as non-diagnostic. No false-positive results were observed. There was a false-negative rate of 5%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 94.3%, 100%, 100%, 72.2% and 95%, respectively. In 23 (88.5%) of 26 aspirated lymph nodes malignancy was found. Minor complications occurred in two patients.
Our experience confirms that EUS-FNA in patients with suspected solid pancreatic lesions is safe and has a high diagnostic accuracy. This technique should be considered the preferred test when a cytological diagnosis of a pancreatic mass lesion is required.
我们报告了在单中心对实性胰腺病变进行内镜超声引导下细针穿刺抽吸术（EUS-FNA）的经验，涉及临床实用性、诊断准确性和安全性。
我们前瞻性地回顾了93例患者（54例男性，平均年龄60.6±12.9岁）连续接受的100例EUS-FNA手术数据，以评估实性胰腺病变。最终诊断基于综合标准：手术中的组织学证据，或FNA时明确的恶性细胞学结果及随访情况。确定了EUS-FNA的操作特征。
73%的病例病变位于胰头，20%位于胰体，7%位于胰尾。病变平均大小为35.1±12.9毫米。最终诊断显示87例为恶性，包括腺癌（80.5%）、神经内分泌肿瘤（11.5%）、淋巴瘤（3.4%）和其他类型（4.6%）。FNA结果为：82%被解释为恶性细胞学，1%为可疑肿瘤，1%为非典型，7%为良性病变，9%为无法诊断。未观察到假阳性结果。假阴性率为5%。敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为94.3%、100%、100%、72.2%和95%。在26例抽吸的淋巴结中，23例（88.5%）发现恶性病变。两名患者出现轻微并发症。
我们的经验证实，对疑似实性胰腺病变患者进行EUS-FNA是安全的，且具有较高的诊断准确性。当需要对胰腺肿块病变进行细胞学诊断时，应将该技术视为首选检查方法。
