Möller Kathleen, Papanikolaou Ioannis S, Toermer Thomas, Delicha Eumorphia M, Sarbia Mario, Schenck Ulrich, Koch Martin, Al-Abadi Hussain, Meining Alexander, Schmidt Harald, Schulz Hans-Joachim, Wiedenmann Bertram, Rösch Thomas
Department of Internal Medicine I, Oskar-Ziethen Hospital Lichtenberg, Berlin, Germany.
Gastrointest Endosc. 2009 Jul;70(1):60-9. doi: 10.1016/j.gie.2008.10.008. Epub 2009 Apr 25.
EUS-guided FNA (EUS-FNA) is an established tissue-acquisition technique, with most studies concentrating on cytologic analyses of specimens, with only few data existing on histologic assessment.
To assess the sensitivity of a combined analysis of histologic followed by cytologic tissue diagnosis.
A retrospective 3-center study.
In consecutive patients undergoing FNA of solid pancreatic masses, core specimens were harvested for histology; residual tissue was examined cytologically. Only unequivocally positive results were regarded as malignant. Criterion standards were positive results from EUS-FNA or other histologic findings, or, if negative, clinical follow-up data (minimum 12 months).
Among 192 patients (110 men; mean age 63 years) with mostly pancreatic-head masses (72.4%), overall, adequate tissue was obtained in 98.9% of all cases, with a mean of 1.88 needle passes and an overall sensitivity of 82.9% (95% CI, 76.0%-88.5%). Histology and subsequent cytology provided adequate tissue and sensitivities of 86.5% and 60%, and 92.7% and 68.1%, respectively. Excluding cases with inadequate specimens, sensitivities rose by 4% to 10%. Histology showed a trend for superiority over cytology only in characterizing nonadenocarcinoma tumor types. No differences in sensitivity were found between the centers involved.
Retrospective design, different processing of cytologic specimens.
At EUS-FNA in pancreatic masses, combined histologic-cytologic analysis achieved a sensitivity of more than 80%, despite a low number of needle passes and may thus save time. Histology alone did not reach higher sensitivity than cytology. In particular situations, eg, rare tumors, histology may still be required.
超声内镜引导下细针穿刺抽吸术（EUS-FNA）是一种成熟的组织获取技术，大多数研究集中于标本的细胞学分析，关于组织学评估的数据较少。
评估组织学联合细胞学组织诊断的敏感性。
一项回顾性三中心研究。
对连续接受实性胰腺肿块细针穿刺抽吸术的患者，获取核心标本进行组织学检查；对剩余组织进行细胞学检查。仅明确阳性结果被视为恶性。标准参照为EUS-FNA的阳性结果或其他组织学发现，若为阴性，则为临床随访数据（至少12个月）。
192例患者（110例男性；平均年龄63岁），多数为胰头肿块（72.4%），总体而言，98.9%的病例获得了足够的组织，平均穿刺1.88针，总体敏感性为82.9%（95%可信区间，76.0%-88.5%）。组织学及随后的细胞学检查分别提供了足够的组织，敏感性分别为86.5%和60%，以及92.7%和68.1%。排除标本不足的病例，敏感性提高了4%至10%。仅在非腺癌肿瘤类型的特征描述方面，组织学显示出优于细胞学的趋势。各参与中心之间在敏感性方面未发现差异。
回顾性设计，细胞学标本处理方式不同。
在胰腺肿块的EUS-FNA中，尽管穿刺针数较少，但组织学联合细胞学分析的敏感性超过80%，因此可能节省时间。单独的组织学检查未达到高于细胞学的敏感性。在特定情况下，如罕见肿瘤，可能仍需要组织学检查。
