Division of Digestive Diseases and Nutrition, The University of Oklahoma, Oklahoma City, Oklahoma, USA.
Gastrointest Endosc. 2012 Apr;75(4):775-82. doi: 10.1016/j.gie.2011.12.015. Epub 2012 Feb 7.
Characterization of pancreatic cysts by using EUS-FNA includes chemical and cytologic analysis.
To evaluate whether material obtained from FNA of the cyst wall increases diagnostic yield.
Prospective series.
Tertiary referral center.
Consecutive patients with pancreatic cysts referred for EUS-FNA between March 2010 and March 2011.
FNA was performed with aspiration of cyst fluid for carcinoembryonic antigen (CEA) and cytology, followed by cyst wall puncture (CWP). CWP is defined as puncturing the far wall of the cyst and moving the needle back and forth through the wall to sample the wall epithelium.
The diagnostic yield for mucinous cystic pancreatic neoplasms by CEA and cytology obtained from cyst fluid compared with cytology obtained from CWP. CEA ≥192 ng/mL was considered mucinous.
A total of 69 pancreatic cysts from 66 patients were included. Adequate amounts of fluid were aspirated for CEA, amylase, and cytology in 60 cysts (81%). Cellular material adequate for cytologic assessment from CWP was obtained in 56 cysts (81%). Ten (30%) of 33 cysts with CEA <192 ng/mL and negative results of cyst fluid cytology had a mucinous diagnosis from CWP; 6 of 9 (67%) cysts with an insufficient amount of fluid for CEA analysis and cyst fluid cytology had a mucinous diagnosis from CWP. Furthermore, 4 malignant cysts were independently diagnosed by CWP cytology. The incremental diagnostic yield of CWP for mucinous or malignant cysts was therefore 29% (20 of 69 cysts, P = .0001). An episode of pancreatitis (1.45%) occurred.
Lack of surgical criterion standard.
CWP during EUS-FNA is a safe and effective technique for improving the diagnostic yield for premalignant and malignant pancreatic cysts.
通过 EUS-FNA 对胰腺囊肿进行特征描述包括化学和细胞学分析。
评估从囊肿壁的 FNA 中获取的物质是否能提高诊断率。
前瞻性系列研究。
三级转诊中心。
2010 年 3 月至 2011 年 3 月间因 EUS-FNA 就诊的连续胰腺囊肿患者。
进行 FNA 时，抽吸囊液用于癌胚抗原（CEA）和细胞学检查，然后进行囊肿壁穿刺（CWP）。CWP 定义为穿刺囊肿的远壁，然后将针来回穿过壁以取样壁上皮。
比较从囊液获得的 CEA 和细胞学检查与从 CWP 获得的细胞学检查对黏液性囊性胰腺肿瘤的诊断率。CEA≥192ng/ml 被认为是黏液性的。
共纳入 66 例患者的 69 个胰腺囊肿。60 个囊肿（81%）中抽吸到足够量的液体进行 CEA、淀粉酶和细胞学检查。56 个囊肿（81%）中获得了足够量的细胞物质用于 CWP 的细胞学评估。33 个 CEA<192ng/ml 和囊液细胞学检查阴性的囊肿中有 10 个（30%）通过 CWP 诊断为黏液性；9 个（67%）CEA 分析和囊液细胞学检查液体量不足的囊肿中有 6 个通过 CWP 诊断为黏液性。此外，4 个恶性囊肿通过 CWP 细胞学检查独立诊断。因此，CWP 对黏液性或恶性囊肿的诊断率增加了 29%（69 个囊肿中有 20 个，P=0.0001）。发生胰腺炎 1 例（1.45%）。
缺乏手术标准。
EUS-FNA 期间的 CWP 是一种安全有效的技术，可提高癌前和恶性胰腺囊肿的诊断率。
