Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Am J Gastroenterol. 2011 Sep;106(9):1705-10. doi: 10.1038/ajg.2011.119. Epub 2011 Apr 12.
The aim of this study was to evaluate the influence of on-site cytopathological evaluation on the diagnostic yield of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) for the differential diagnosis of solid pancreatic masses in an unselected series of consecutive patients.
Patients undergoing EUS-guided FNA of solid pancreatic lesions over a 2-year study period were included. Samples were either evaluated on site by a cytopathologist or processed by the endoscopist and sent to the pathology department for evaluation. Diagnostic accuracy for malignancy, number of needle passes, adequate-specimen collection rate, cytological diagnosis, and final diagnosis, and complication rate according to the presence or absence of on-site cytopathologist were evaluated.
A total of 182 patients were included. An on-site cytopathologist was available in 95 cases (52.2%). There was no difference between groups in terms of age, sex, location, and size of the lesions. A significantly higher number of needle passes was performed when an on-site cytopathologist was not available (3.5±1.0 vs. 2.0±0.7; P<0.001). The presence of an on-site cytopathologist was associated with a significantly lower number of inadequate samples (1.0 vs. 12.6%, P=0.002), and a significantly higher diagnostic sensitivity (96.2 vs. 78.2%; P=0.002) and overall accuracy (96.8 vs. 86.2%; P=0.013) for malignancy. Three patients developed complications (two acute pancreatitis, one local bleeding), all of them belonging to the group without on-site cytopathology.
On-site cytopathological evaluation improves the diagnostic yield of EUS-guided FNA for the cytological diagnosis of solid pancreatic masses. This is associated with a significantly lower number of inadequate samples and a lower number of needle passes.
本研究旨在评估现场细胞学评估对超声内镜 (EUS) 引导下细针抽吸 (FNA) 用于鉴别诊断未经选择的连续患者的胰腺实性肿块的诊断效果的影响。
纳入在 2 年研究期间接受 EUS 引导下胰腺实性病变 FNA 的患者。标本由细胞学专家在现场评估，或由内镜医生处理并发送到病理科进行评估。根据是否有现场细胞学专家评估恶性肿瘤的诊断准确性、穿刺次数、标本采集充分率、细胞学诊断和最终诊断以及并发症发生率。
共纳入 182 例患者。95 例（52.2%）有现场细胞学专家。两组患者的年龄、性别、病变位置和大小无差异。当没有现场细胞学专家时，穿刺次数明显增加（3.5±1.0 比 2.0±0.7；P<0.001）。有现场细胞学专家时，样本不足的数量明显减少（1.0 比 12.6%；P=0.002），恶性肿瘤的诊断敏感性（96.2 比 78.2%；P=0.002）和总体准确性（96.8 比 86.2%；P=0.013）明显提高。3 例患者出现并发症（2 例急性胰腺炎，1 例局部出血），均属于无现场细胞学专家组。
现场细胞学评估可提高 EUS 引导下 FNA 对胰腺实性肿块的细胞学诊断的诊断效果。这与样本不足的数量明显减少和穿刺次数减少有关。
