Imaoka Hiroshi, Yamao Kenji, Bhatia Vikram, Shimizu Yasuhiro, Yatabe Yasushi, Koshikawa Takashi, Kinoshita Yoshikazu
Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden Chikusa-ku, Nagoya 464-8681, Japan.
J Gastroenterol. 2009;44(2):146-53. doi: 10.1007/s00535-008-2282-6. Epub 2009 Feb 13.
Tumors other than ductal adenocarcinomas constitute 10%-15% of all pancreatic tumors. We describe the performance and pitfalls of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for diagnosis of these rare pancreatic tumors and their characteristic cytopathological features.
The records of 455 pancreatic fine-needle aspiration procedures done between March 1997 and August 2006 at Aichi Cancer Center, Nagoya, Japan, were reviewed. Besides cytology, aspirated material was routinely submitted in formalin for cell-block analysis. The reference standard for final diagnosis was surgical pathology from resected specimens.
Twenty-eight rare (nonductal adenocarcinomas) pancreatic tumors were identified. Overall, EUS-FNA with the results of cytology, cell-block processing, and immunohistochemistry could correctly diagnose the type of neoplasm in 19 (67.9%) cases. EUS-FNA could distinguish benign from malignant rare tumors with a sensitivity of 69.2%, a specificity of 100%, positive predictive value of 100%, negative predictive value of 79.0%, and accuracy of 85.7%. None of three malignant pancreatic endocrine neoplasms could be diagnosed as malignant. An adequate core tissue sample could be obtained in 21 cases (75.0%) and provide a histopathological diagnosis in 19 (67.9%) cases. EUS-FNA could change the presumptive diagnosis in 11 (39.3%) cases. Specific immunochemical studies were useful adjuncts to the diagnosis. No major or minor complication was noted in any patient.
Pancreatic neoplasms other than ductal adenocarcinomas have diverse imaging and histopathological features. EUS-FNA is accurate and safe for their identification.
除导管腺癌外的肿瘤占所有胰腺肿瘤的10%-15%。我们描述了内镜超声引导下细针穿刺抽吸术（EUS-FNA）在诊断这些罕见胰腺肿瘤方面的表现及陷阱，以及它们的特征性细胞病理学特征。
回顾了1997年3月至2006年8月在日本名古屋爱知癌症中心进行的455例胰腺细针穿刺抽吸手术记录。除了细胞学检查外，抽吸物常规用福尔马林固定用于细胞块分析。最终诊断的参考标准是切除标本的手术病理学检查。
共识别出28例罕见（非导管腺癌）胰腺肿瘤。总体而言，结合细胞学、细胞块处理及免疫组化结果的EUS-FNA能够在19例（67.9%）病例中正确诊断肿瘤类型。EUS-FNA能够区分良性与恶性罕见肿瘤，其敏感性为69.2%，特异性为100%，阳性预测值为100%，阴性预测值为79.0%，准确性为85.7%。3例恶性胰腺内分泌肿瘤均未能诊断为恶性。21例（75.0%）病例获得了足够的核心组织样本，其中19例（67.9%）提供了组织病理学诊断。EUS-FNA能够在11例（39.3%）病例中改变初步诊断。特异性免疫化学研究对诊断有辅助作用。未观察到任何患者出现严重或轻微并发症。
除导管腺癌外的胰腺肿瘤具有多样的影像学和组织病理学特征。EUS-FNA对其识别准确且安全。
