EUS 引导下的单切口针刀活检：一种用于胃黏膜下 GI 肿瘤组织取样的新方法的描述和结果（附视频）。
EUS-guided single-incision needle-knife biopsy: description and results of a new method for tissue sampling of subepithelial GI tumors (with video).
机构信息
Division of Digestive Endoscopy, Department of Gastroenterology, Río Hortega Hospital, Valladolid, Spain.
出版信息
Gastrointest Endosc. 2011 Sep;74(3):672-6. doi: 10.1016/j.gie.2011.05.042.
BACKGROUND
The diagnostic efficacy of current tissue sampling techniques for upper GI subepithelial tumors (SETs) appears to be limited. Better tissue acquisition techniques are needed to improve the diagnostic yield in this setting.
OBJECTIVE
Our purpose was to determine the safety and diagnostic yield of EUS-guided needle-knife incision and forceps biopsy (SINK biopsy) of upper GI SETs.
DESIGN
Retrospective database review.
SETTING
Academic tertiary-care referral center.
PATIENTS
This study involved 14 consecutive patients referred for EUS evaluation of upper GI SETs with previous unsuccessful attempts at tissue diagnosis by conventional forceps biopsy.
INTERVENTION
EUS-guided needle-knife incision and forceps biopsy.
MAIN OUTCOME MEASUREMENTS
The safety and diagnostic yield of this method, compared with EUS-guided fine-needle aspiration (EUS-FNA), when possible.
RESULTS
SINK biopsy provided tissue samples that were sufficient for definite histologic diagnosis in 13 of 14 cases (diagnostic yield 92.8%). There were 8 gastric GI stromal tumors. In 7 of 8, the size of SINK specimens allowed immunohistochemical analysis, and the evaluation of malignant potential was carried out by means of mitotic index determination in 5 cases (71.42%). SINK biopsies determined the pathological diagnosis of all (4 of 4) nonmesenchymal lesions. Eight patients underwent both EUS-FNA and SINK, with final histologic diagnosis determined in 6 of 8 cases (75%) by SINK versus 1 of 8 cases (12.5%) by EUS-FNA (Fisher exact test, P = .023). There were no procedure-related complications.
LIMITATIONS
A single-center, retrospective analysis with small sample size.
CONCLUSION
SINK biopsy appears to be an easy, safe, and effective technique for determining the definitive pathological diagnosis, evaluation of the malignant potential, and planning management of SETs. It could be a reliable alternative to conventional FNA, providing larger samples that improve the histologic yield.
背景
目前用于上消化道黏膜下肿瘤（SET）的组织采样技术的诊断效果似乎有限。需要更好的组织采集技术来提高这种情况下的诊断率。
目的
我们旨在确定 EUS 引导下针刀切开和活检钳活检（SINK 活检）对上消化道 SET 的安全性和诊断率。
设计
回顾性数据库研究。
地点
学术三级转诊中心。
患者
这项研究涉及 14 例连续患者，他们因上消化道 SET 接受 EUS 评估，此前常规活检钳活检未能获得组织诊断。
干预措施
EUS 引导下针刀切开和活检钳活检。
主要观察指标
与可能的 EUS 引导下细针抽吸（EUS-FNA）相比，这种方法的安全性和诊断率。
结果
SINK 活检在 14 例病例中的 13 例（诊断率 92.8%）提供了足够的组织样本，以进行明确的组织学诊断。有 8 例胃胃肠道间质瘤。在 8 例中的 7 例中，SINK 标本的大小允许进行免疫组织化学分析，通过 5 例（71.42%）的有丝分裂指数测定评估恶性潜能。SINK 活检确定了所有（4 例中的 4 例）非间质性病变的病理诊断。8 例患者同时接受了 EUS-FNA 和 SINK，其中 6 例（75%）通过 SINK 确定了最终的组织学诊断，8 例中的 1 例（12.5%）通过 EUS-FNA 确定（Fisher 确切检验，P =.023）。没有与程序相关的并发症。
局限性
单中心、回顾性分析，样本量小。
结论
SINK 活检似乎是一种简单、安全、有效的技术，可用于确定明确的病理诊断、评估恶性潜能并规划 SET 的管理。它可以作为常规 FNA 的可靠替代方法，提供更大的样本，提高组织学检出率。
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