Division of Gastroenterology-Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Gastrointest Endosc. 2012 Jul;76(1):76-83. doi: 10.1016/j.gie.2012.02.049.
Few studies have evaluated the impact of biliary stents on EUS-guided FNA.
To compare diagnostic yield of EUS-FNA in patients with or without biliary stents.
Retrospective study.
Tertiary referral center.
Patients with obstructive jaundice secondary to solid pancreatic mass lesions who underwent EUS-FNA over 5 years.
The primary objective was to compare the diagnostic accuracy of EUS-FNA in patients with or without biliary stents and between patients with plastic stents or self-expandable metal stents (SEMSs). Secondary objectives were to assess the technical difficulty of EUS-FNA by comparing the number of passes required to establish diagnosis and to identify predictors of a false-negative diagnosis.
Of 214 patients who underwent EUS-FNA, 150 (70%) had biliary stents and 64 (30%) had no stents in place. Of 150 patients with biliary stents, 105 (70%) were plastic and 45 (30%) were SEMSs. At EUS-FNA, the diagnosis was pancreatic cancer in 155 (72%), chronic pancreatitis in 17 (8%), other cancer in 31 (14%), and indeterminate in 11 (5%). There was no difference in rates of diagnostic accuracy between patients with or without stents (93.7% vs 95.3%; P = .73) and between plastic or SEMSs (95.2% vs 95.5%, P = .99), respectively. Median number of passes to diagnosis was not significantly different between patients with or without stents (2 [interquartile ratio range (IQR) = 1-3] vs 2 [IQR = 1-4]; P = .066) and between plastic or SEMS (2.5 [IQR = 1-4] vs 2 [IQR = 1-4], P = .69), respectively. On univariate analysis, EUS-FNA results were false-negative in patients with large pancreatic masses (>3 cm vs <3 cm, 9.35% vs 0.93%, P = .005) that required more FNA passes (<2 vs >2 passes, 0% vs 11.8%, P < .0001).
Retrospective study.
The presence or absence of a biliary stent, whether plastic or metal, does not have an impact on the diagnostic yield or technical difficulty of EUS-FNA.
很少有研究评估胆管支架对 EUS-FNA 的影响。
比较有或无胆管支架的患者行 EUS-FNA 的诊断率。
回顾性研究。
三级转诊中心。
5 年内因胰腺实性肿块病变导致阻塞性黄疸而行 EUS-FNA 的患者。
主要目的是比较有或无胆管支架的患者以及塑料支架或自膨式金属支架（SEMS）患者的 EUS-FNA 诊断准确性。次要目的是通过比较建立诊断所需的穿刺次数来评估 EUS-FNA 的技术难度，并确定假阴性诊断的预测因素。
在 214 例行 EUS-FNA 的患者中，150 例（70%）有胆管支架，64 例（30%）无支架。在 150 例有胆管支架的患者中，105 例（70%）为塑料支架，45 例（30%）为 SEMS。在 EUS-FNA 检查中，诊断为胰腺癌 155 例（72%），慢性胰腺炎 17 例（8%），其他癌症 31 例（14%），不确定 11 例（5%）。有或无支架的患者（93.7% vs 95.3%；P =.73）以及塑料支架或 SEMS 支架的患者（95.2% vs 95.5%；P =.99）之间的诊断准确率无差异。有或无支架的患者（支架：2 [四分位间距范围（IQR）= 1-3] vs 无支架：2 [IQR = 1-4]；P =.066）以及塑料支架或 SEMS 支架的患者（支架：2.5 [IQR = 1-4] vs 无支架：2 [IQR = 1-4]；P =.69）之间，达到诊断所需的穿刺次数中位数无显著差异。单因素分析显示，EUS-FNA 结果在胰腺肿块较大（>3 cm 与 <3 cm，9.35% 与 0.93%，P =.005）和需要更多穿刺（<2 次与 >2 次，0% 与 11.8%，P <.0001）的患者中为假阴性。
回顾性研究。
胆管支架的存在与否，无论是塑料支架还是金属支架，都不会影响 EUS-FNA 的诊断率或技术难度。
