Knight Carrie S, Eloubeidi Mohamad A, Crowe Ralph, Jhala Nirag C, Jhala Darshana N, Chhieng David C, Eltoum Isam A
Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
Diagn Cytopathol. 2013 Dec;41(12):1031-7. doi: 10.1002/dc.21804. Epub 2011 Sep 19.
The objective of this study is to assess the utility of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in the diagnosis and staging of colorectal cancer. The study includes patients who underwent EUS-FNA at our institution for staging of colorectal carcinoma or for evaluation peri-rectal masses or distal metastases from August 2000 to November 2010. We assessed the frequency with which EUS-FNA procedure confirms the diagnosis of malignancy and the percent of cases in which it modifies staging of colorectal carcinoma. Using histology as a reference standard, we also assessed the diagnostic performance. We identified 79 cases of EUS-FNA from 77 patients, mean (SD) age of 60 (12.5), 44 males. Twenty-seven (34%) aspirates were from patients with primary rectal/peri-rectal masses, 15 (19%) were from patients with suspected regional lymph node metastasis, and 37 (47%) were cases of suspected of distal metastasis. All lesions were clinically suspicious for primary or metastatic colorectal carcinoma. On cytologic examinations, 43 (54%) cases were confirmed as malignant, 6 (8%) were benign neoplasms, 4 (5%) were suspicious for malignant neoplasm, 2 (3%) showed atypical cells, and the rest 24 (30%) were negative for neoplasms. Fourteen of 27 (52%) of the local rectal masses were confirmed as colorectal carcinoma. Eleven of 15 (73%) regional lymph nodes were positive for metastasis-all, but two of these metastases, were of colorectal origin. Twenty of 37(54%) distal lesions were metastatic neoplasms and 15 of those were colorectal in origin. Diagnosis of primary colorectal carcinoma was confirmed in 52% of the clinically suspicious primary lesions and in 42% regional or distal metastatic lesions. Using histology as a reference standard in 27 of 79 (29%) cases, we calculated an overall sensitivity, specificity, and positive and negative predictive values (C.I) of EUS-FNA of 89% (74-100%), 79% (50-100%) 89% (74-100%), and 79% (51-100%). EUS-FNA is useful for assessing primary and metastatic colorectal lesion. This technique improves staging of suspected nodal or distant metastases.
本研究的目的是评估内镜超声引导下细针穿刺抽吸术（EUS-FNA）在结直肠癌诊断和分期中的应用价值。该研究纳入了2000年8月至2010年11月期间在我院接受EUS-FNA以进行结直肠癌分期、评估直肠周围肿物或远处转移的患者。我们评估了EUS-FNA procedure确诊恶性肿瘤的频率以及改变结直肠癌分期的病例百分比。以组织学为参考标准，我们还评估了其诊断性能。我们从77例患者中识别出79例EUS-FNA病例，平均（标准差）年龄为60岁（12.5），男性44例。27例（34%）抽吸样本来自原发性直肠/直肠周围肿物患者，15例（19%）来自疑似区域淋巴结转移患者，37例（47%）为疑似远处转移病例。所有病变在临床上均怀疑为原发性或转移性结直肠癌。在细胞学检查中，43例（54%）病例确诊为恶性，6例（8%）为良性肿瘤，4例（5%）疑似恶性肿瘤，2例（3%）显示非典型细胞，其余24例（30%）肿瘤检查为阴性。27例直肠局部肿物中有14例（52%）确诊为结直肠癌。15例区域淋巴结中有11例（73%）转移阳性——除2例转移外，其余均为结直肠来源。37例远处病变中有20例（54%）为转移性肿瘤，其中15例为结直肠来源。52%的临床可疑原发性病变以及42%的区域或远处转移性病变确诊为原发性结直肠癌。以组织学为参考标准，在79例中的27例（29%）病例中，我们计算出EUS-FNA的总体敏感性、特异性、阳性和阴性预测值（置信区间）分别为89%（74-100%）、79%（50-100%）、89%（74-100%）和79%（51-100%）。EUS-FNA有助于评估原发性和转移性结直肠病变。该技术可改善疑似淋巴结或远处转移的分期。
