Sepe Paul S, Moparty Bhavani, Pitman Martha B, Saltzman John R, Brugge William R
Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Gastrointest Endosc. 2009 Aug;70(2):254-61. doi: 10.1016/j.gie.2008.11.038. Epub 2009 May 30.
EUS-guided FNA has been well documented to aid in the diagnosis of subepithelial lesions by providing cytologic material. Studies to date evaluating the sensitivity of EUS-FNA for the diagnosis of GI stromal cell tumors (GIST) have been small, and few have relied on surgical histologic diagnosis as the reference standard.
Our purpose was to determine the diagnostic yield and sensitivity of EUS-FNA for the diagnosis of GIST and to identify EUS features of GIST that are predictive of the ability to obtain adequate tissue by EUS-FNA.
All patients with histologically confirmed, c-kit-positive GIST who underwent EUS-FNA from 1998 to 2006 were reviewed. EUS images were examined for mass size, shape, location, wall layer, heterogeneity, echogenicity, cystic spaces, lobulation, ulceration, and central umbilication. Needle gauge, number of needle passes, and presence of a cytologist during the EUS-FNA were recorded.
A total of 37 patients (29 with diagnostic FNA cytology; 8 with nondiagnostic cytology) met the inclusion criteria. The diagnostic yield and sensitivity of EUS-FNA cytology for the diagnosis of GIST was 78.4% (29/37). The sensitivity was 84.4% (27/32) for GISTs located in the stomach, but poor for lesions located in the duodenum because none of these tumors yielded diagnostic cytology (n = 3). An increase in size up to 10 cm, round/oval shape, and identification of the origin of GIST within a specific sonographic wall layer were statistically significant in their ability to predict adequate tissue yield.
The sensitivity of EUS-FNA cytology for the diagnosis of GIST is 78.4% and is influenced by size, location, shape, and layer of origin.
超声内镜引导下细针穿刺抽吸术（EUS-FNA）通过提供细胞学材料辅助诊断上皮下病变，这已得到充分证实。迄今为止，评估EUS-FNA诊断胃肠道间质细胞瘤（GIST）敏感性的研究规模较小，且很少有研究将手术组织学诊断作为参考标准。
我们的目的是确定EUS-FNA诊断GIST的诊断率和敏感性，并识别GIST的超声内镜特征，这些特征可预测通过EUS-FNA获取足够组织的能力。
回顾了1998年至2006年期间所有经组织学证实为c-kit阳性GIST且接受EUS-FNA的患者。检查超声内镜图像的肿块大小、形状、位置、壁层、异质性、回声性、囊性间隙、分叶、溃疡和中央凹陷。记录EUS-FNA期间的针号、穿刺针数以及是否有细胞病理学家在场。
共有37例患者（29例FNA细胞学诊断阳性；8例细胞学诊断阴性）符合纳入标准。EUS-FNA细胞学诊断GIST的诊断率和敏感性为78.4%（29/37）。位于胃的GIST敏感性为84.4%（27/32），但位于十二指肠的病变敏感性较差，因为这些肿瘤均未获得诊断性细胞学结果（n = 3）。大小增加至10 cm、圆形/椭圆形以及在特定超声壁层内识别GIST的起源在预测获得足够组织产量的能力方面具有统计学意义。
EUS-FNA细胞学诊断GIST的敏感性为78.4%，并受大小、位置、形状和起源层的影响。
