Department of Medicine, Division of Gastroenterology & Hepatology, Thomas Jefferson University Hospital, USA.
J Clin Gastroenterol. 2011 Feb;45(2):164-9. doi: 10.1097/MCG.0b013e3181eed6d2.
Pancreatic cysts are common, however, their diagnosis and classification remains a challenge despite advances in cross-sectional imaging and endoscopic ultrasound with fine needle aspiration (EUS-FNA).
To determine the incremental yield of cytologic examination of material obtained from targeted fine needle aspiration ("puncture") of the cyst wall after aspiration of fluid for CEA.
Retrospective consecutive series.
Consecutive patients undergoing EUS-FNA of a pancreatic cyst by 2 expert endoscopists at a single tertiary care center between January 2006 and June 2008.
Standard EUS-FNA of pancreatic cysts was carried out, and after cyst fluid aspiration the cyst wall was punctured and aspirated (CWP) to obtain epithelium for cytologic analysis.
The diagnostic yields of carcinoembryonic antigen (CEA) obtained from cyst fluid and of cytology obtained from CWP. CEA greater than192 ng/mL was considered diagnostic of a mucinous cyst.
One hundred seven patients underwent EUS-FNA with CWP. Sixteen (31%) of 52 patients with CEA <192 ng/mL had cytology positive for mucinous epithelium, whereas 15 (47%) of 32 cysts with an insufficient amount of fluid for CEA analysis had positive cytology from CWP. The additional, cumulative diagnostic yield for mucinous cysts was therefore, 37%. Of 55 cysts diagnosed as mucinous, more (56%) were diagnosed by CWP cytology alone than by CEA (P<0.05).
Retrospective design and limited surgical pathology.
Cyst wall puncture and aspiration during routine EUS-FNA may be a safe, easily applied, and inexpensive technique for improving the diagnostic yield for mucinous cysts of the pancreas.
胰腺囊肿很常见，但是尽管影像学和内镜超声引导下细针抽吸术（EUS-FNA）有了进步，其诊断和分类仍然是一个挑战。
确定在抽吸囊液用于癌胚抗原（CEA）检测之后，对囊肿壁进行靶向细针抽吸（“穿刺”）获得的细胞检查材料的额外收益。
回顾性连续系列。
2 位专家内镜医生于 2006 年 1 月至 2008 年 6 月在一家三级保健中心对连续胰腺囊肿进行 EUS-FNA。
对胰腺囊肿进行标准 EUS-FNA，抽吸囊液后，对囊肿壁进行穿刺抽吸（CWP）以获得上皮细胞进行细胞学分析。
从囊液中获得的癌胚抗原（CEA）和从 CWP 中获得的细胞学检查的诊断率。CEA 大于 192ng/mL 被认为是黏液性囊肿的诊断标准。
107 例患者接受了 EUS-FNA 联合 CWP。52 例 CEA<192ng/mL 的患者中有 16 例（31%）的 CWP 细胞学检查显示黏液上皮阳性，而 32 例囊液量不足以进行 CEA 分析的囊肿中有 15 例（47%）的 CWP 细胞学检查阳性。因此，黏液性囊肿的额外累积诊断率为 37%。在 55 个被诊断为黏液性的囊肿中，有更多（56%）是通过 CWP 细胞学检查而不是 CEA 单独诊断的（P<0.05）。
回顾性设计和有限的外科病理学。
在常规 EUS-FNA 期间对囊肿壁进行穿刺抽吸可能是一种安全、易于应用且经济的技术，可以提高胰腺黏液性囊肿的诊断率。
