Department of Medicine A, Gastroenterology, Endocrinology, Nutrition and Nephrology University Hospital, Ernst-Moritz-Arndt-Universität Greifswald, Friedrich-Loeffler-Strasse 23a, D-17475, Greifswald, Germany.
Surg Endosc. 2009 Oct;23(10):2351-5. doi: 10.1007/s00464-009-0345-2. Epub 2009 Mar 5.
Fine-needle aspiration (FNA) is a well-established technique to obtain cytological specimens, but it does not permit the extraction of histological tissue-core samples, which, if available, may increase the yield and accuracy of the histopathological diagnosis. This prospective study was designed to assess the yield and diagnostic accuracy of endoscopic ultrasound (EUS)-guided Trucut needle biopsy (TNB) as first-line diagnostic method for suspected malignant lesions identified by upper gastrointestinal EUS.
In a prospective case series, 24 consecutive patients (14 women; median age, 68 (range, 38-84) years) with suspected malignancy underwent EUS-TNB with a 19-gauge needle. EUS was performed with a linear scanning echo endoscope. When the EUS-TNB device did not collect adequate samples, subsequent EUS-FNA was performed. The presence or absence of malignancy was confirmed by postoperative histopathology or diagnostic imaging follow-up for at least 9 months.
Adequate tissue specimens were obtained in 20 of 24 (83%) patients by TNB. An accurate diagnosis was achieved in 19 of 20 (95%) patients in whom TNB was successful with a sensitivity and specificity of 93% and 100%, respectively. In 11 patients malignant disease was found, whereas 8 patients showed benign lesions on TNB-obtained histopathology. Thirteen patients underwent additional EUS-FNA. The diagnosis by TNB was confirmed in seven of nine (78%) patients with additional FNA. In three of four patients with inadequate TNB, the diagnosis was established by FNA. The overall accuracy of EUS-TNB was 79% (19/24) for all patients and 92% (22/24) with subsequent FNA. The positive and negative predictive values for the diagnosis of a malignant lesion by EUS-TNB were 57.9% and 88.9%, respectively. Neither method had any procedure-related complications.
EUS-guided TNB is a safe and accurate technique to obtain core specimen for histopathologic diagnosis in patients with suspected malignancies on upper gastrointestinal EUS. FNA can serve as rescue technique and should be performed if TNB fails to obtain adequate tissue samples.
细针抽吸（FNA）是获取细胞学标本的成熟技术，但它不允许提取组织芯样本，如果有组织芯样本，可能会提高组织病理学诊断的准确性和阳性率。本前瞻性研究旨在评估内镜超声（EUS）引导下 Trucut 针活检（TNB）作为上消化道 EUS 发现的可疑恶性病变的一线诊断方法的阳性率和诊断准确性。
在一项前瞻性病例系列研究中，对 24 例连续疑似恶性病变的患者（14 例女性；中位年龄 68 岁[范围 38-84 岁]）进行 EUS-TNB 检查，使用 19 号针。EUS 使用线性扫描超声内镜进行。当 EUS-TNB 装置未收集到足够的样本时，随后进行 EUS-FNA。通过术后组织病理学或至少 9 个月的诊断影像学随访来确认是否存在恶性肿瘤。
TNB 成功获得了 24 例患者中的 20 例（83%）的充分组织标本。在 20 例 TNB 成功的患者中，19 例（95%）获得了准确的诊断，其敏感性和特异性分别为 93%和 100%。11 例患者发现恶性疾病，而 8 例患者 TNB 获得的组织病理学显示良性病变。13 例患者进行了额外的 EUS-FNA。在另外接受 FNA 的 9 例患者中，有 7 例（78%）通过 TNB 诊断得到了确认。在 TNB 不足的 4 例患者中，有 3 例通过 FNA 建立了诊断。对于所有患者，EUS-TNB 的总体准确性为 79%（24/24），随后进行 FNA 为 92%（24/24）。EUS-TNB 诊断恶性病变的阳性预测值和阴性预测值分别为 57.9%和 88.9%。两种方法均无相关操作并发症。
EUS 引导下的 TNB 是一种安全、准确的技术，可在上消化道 EUS 发现的疑似恶性肿瘤患者中获得用于组织病理学诊断的核心标本。如果 TNB 未能获得足够的组织样本，FNA 可以作为挽救性技术。
