Department of Pathology & Laboratory Medicine, University of California Irvine Medical Center, Irvine, CA, USA.
Cancer Cytopathol. 2011 Feb 25;119(1):27-36. doi: 10.1002/cncy.20123. Epub 2010 Nov 11.
Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has been widely used for the diagnosis of primary and metastatic gastrointestinal (GI) and non-GI malignancies. Few studies have been published to evaluate the accuracy and the cytologic features of EUS-guided paracentesis in the diagnosis and staging of malignant neoplasms.
All EUS-guided paracenteses of ascitic fluid performed at the University of California Irvine Medical Center (UCIMC) from January 2003 to February 2006 were retrospectively retrieved. Corresponding EUS findings, cytology and histology slides, and follow-up information were reviewed.
One hundred one (101) cases were found. Two smears were submitted in 11 cases because of the scanty amount of fluid aspirated. In the remaining cases, 5 mL or less of fluid were aspirated in 56 patients, and, of 9 who had prior computed tomography (CT), ascitic fluid was not seen in 6. The cytologic diagnoses were as follows: 17 were positive for adenocarcinoma, 1 positive for metastatic small-cell carcinoma of the lung, 1 positive for diffuse large-cell lymphoma, 3 suspicious for adenocarcinoma, 1 suspicious for plasmacytoma, 4 atypical epithelial cells, and 74 negative. Cell block was available in 80 cases and immunohistochemical stains were performed in 71 cases to confirm the diagnosis. Six patients had peritoneal biopsy. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were 80%, 100%, 100%, 95%, and 96%, respectively.
EUS-guided paracentesis is a valuable aid in the cytologic diagnosis of malignant ascites. It is particularly useful when no abnormality is identified by CT.
内镜超声（EUS）引导下细针抽吸（FNA）已广泛应用于原发性和转移性胃肠道（GI）和非 GI 恶性肿瘤的诊断。很少有研究评估 EUS 引导下腹腔穿刺术在恶性肿瘤诊断和分期中的准确性和细胞学特征。
回顾性检索 2003 年 1 月至 2006 年 2 月在加利福尼亚大学欧文医学中心（UCIMC）进行的所有 EUS 引导下腹腔积液穿刺术。回顾了相应的 EUS 发现、细胞学和组织学切片以及随访信息。
共发现 101 例。由于抽吸的液体量少，11 例送检了 2 张涂片。在其余病例中，56 例患者抽吸的液体少于 5 毫升，9 例患者中有 CT 检查的 6 例未见腹水。细胞学诊断如下：17 例为腺癌阳性，1 例为转移性小细胞肺癌阳性，1 例为弥漫性大 B 细胞淋巴瘤阳性，3 例可疑为腺癌，1 例可疑为浆细胞瘤，4 例非典型上皮细胞，74 例为阴性。80 例有细胞块，71 例进行了免疫组织化学染色以确认诊断。6 例患者行腹膜活检。其灵敏度、特异性、阳性预测值、阴性预测值和诊断准确率分别为 80%、100%、100%、95%和 96%。
EUS 引导下腹腔穿刺术是恶性腹水细胞学诊断的有价值的辅助手段。当 CT 未发现异常时尤其有用。
