Thomas T, Kaye P V, Ragunath K, Aithal G P
Nottingham Digestive Diseases Centre: BioMedical Research Unit, Nottingham University Hospitals NHS Trust, Queens Medical Centre, United Kingdom.
Endoscopy. 2009 Apr;41(4):335-9. doi: 10.1055/s-0029-1214470. Epub 2009 Apr 1.
Esophageal and/or gastric wall thickening raises the possibility of malignancy. Endoscopic-ultrasound-(EUS-)guided targeted biopsy of the thickened wall is possible. We aimed to evaluate the efficacy and safety of EUS-guided mural trucut biopsies (TCB) in detecting underlying malignancy in patients with thickened esophagogastric wall and negative mucosal biopsies.
Patients with alarm symptoms referred for EUS-guided sampling after negative endoscopy and mucosal biopsy were included in the study. All patients had radial EUS reporting abnormal thickening of the esophageal/gastric wall. A linear-array echoendoscope and a 19-gauge trucut needle were used for sampling. Clinical and investigatory data were collected prospectively between 2004 and 2008.
Thirty-one patients (20 men) aged 60 - 74 years (median 67 years) were included. All patients had thickened esophageal wall (n = 10), gastric wall (n = 21), or both on radial EUS. Prior to EUS, patients had undergone 1 - 5 endoscopies (median 1.2) and 2 - 8 mucosal biopsies (median 4). The median esophageal and gastric wall thicknesses were 12 and 18 mm respectively. During sampling 1 - 5 needle punctures (median 3) were made. On EUS-TCB, an adequate specimen for histology was obtained in 28/31 patients (90 %). The size of the tissue cores was 4 - 10 mm (median 6mm). Malignancy was confirmed in 16/31 patients (54 %) on histology, and in 11/31 patients (35.4 %) an underlying malignancy was excluded. There was no significant correlation between wall thickness and biopsy size (rho = 0.11, 95 %CI- 0.25 to - 0.45, two-sided P = 0.53). EUS-TCB had sensitivity, specificity, and positive and negative predictive values of 85 %, 100 %, 100 %, and 74 % respectively. There were no immediate or late complications.
EUS-guided mural TCB is a safe and effective technique in the investigation of esophagogastric wall thickening in patients with alarm symptoms and has high sensitivity and specificity for the diagnosis of a cancer.
食管和/或胃壁增厚增加了恶性肿瘤的可能性。内镜超声（EUS）引导下对增厚壁进行靶向活检是可行的。我们旨在评估EUS引导下壁层切割活检（TCB）在检测食管胃壁增厚且黏膜活检阴性患者潜在恶性肿瘤方面的有效性和安全性。
研究纳入了在内镜检查和黏膜活检阴性后因有警示症状而接受EUS引导下采样的患者。所有患者的径向EUS均报告食管/胃壁异常增厚。使用线阵超声内镜和19号切割针进行采样。前瞻性收集了2004年至2008年期间的临床和调查数据。
纳入了31例患者（20例男性），年龄60 - 74岁（中位年龄67岁）。所有患者在径向EUS检查中均有食管壁增厚（n = 10）、胃壁增厚（n = 21）或两者均增厚。在进行EUS之前，患者已接受1 - 5次内镜检查（中位次数1.2次）和2 - 8次黏膜活检（中位次数4次）。食管和胃壁的中位厚度分别为12毫米和18毫米。采样过程中进行了1 - 5次针刺（中位次数3次）。在EUS - TCB检查中，28/31例患者（90%）获得了足够用于组织学检查的标本。组织芯大小为4 - 10毫米（中位大小6毫米）。组织学检查确诊16/31例患者（54%）患有恶性肿瘤，11/31例患者（35.4%）排除了潜在恶性肿瘤。壁厚度与活检大小之间无显著相关性（rho = 0.11，95%CI - 0.25至 - 0.45，双侧P = 0.53）。EUS - TCB的敏感性、特异性、阳性预测值和阴性预测值分别为85%、100%、100%和74%。未出现即刻或晚期并发症。
EUS引导下壁层TCB是一种安全有效的技术，可用于对有警示症状的食管胃壁增厚患者进行检查，对癌症诊断具有高敏感性和特异性。
