Bluen Benjamin Ephraim, Lachter Jesse, Khamaysi Iyad, Kamal Yassin, Malkin Leonid, Keren Ruth, Epelbaum Ron, Kluger Yoram
Technion-Israel Institute of Technology, The Bruce and Ruth Rappaport Faculty of Medicine, Israel.
Diagn Ther Endosc. 2012;2012:139563. doi: 10.1155/2012/139563. Epub 2012 Oct 31.
Introduction. Thorough quality control (QC) study with systemic monitoring and evaluation is crucial to optimizing the effectiveness of EUS-FNA. Methods. Retrospective analysis was composed of investigating consecutive patient files that underwent EUS-FNA. QC specifically focused on diagnostic accuracy, impacts on preexisting diagnoses, and case management. Results. 268 patient files were evaluated. EUS-FNA cytology helped establish accurate diagnoses in 92.54% (248/268) of patients. Sensitivity, specificity, PPV, NPV, and accuracy were 83%, 100%, 100%, 91.6%, and 94%, respectively. The most common biopsy site was the pancreas (68%). The most accurate location for EUS-FNA was the esophagus, 13/13 (100%), followed by the pancreas (89.6%). EUS-FNA was least informative for abdominal lymph nodes (70.5%). After FNA and followup, eight false negatives for tumors were found (3%), while 7.5% of samples still lacked a definitive diagnosis. Discussion. QC suggests that the diagnostic accuracy of EUS-FNA might be improved further by (1) taking more FNA passes from suspected lesions, (2) optimizing needle selection (3) having an experienced echo-endoscopist available during the learning curve, and (4) having a cytologist present during the procedure. QC also identified remediable reporting errors. In conclusion, QC study is valuable in identifying weaknesses and thereby augmenting the effectiveness of EUS-FNA.
引言。通过系统的监测和评估进行全面的质量控制（QC）研究对于优化超声内镜引导下细针穿刺活检（EUS-FNA）的有效性至关重要。方法。回顾性分析包括调查连续接受EUS-FNA的患者病历。质量控制特别关注诊断准确性、对既往诊断的影响以及病例管理。结果。评估了268份患者病历。EUS-FNA细胞学检查帮助92.54%（248/268）的患者建立了准确诊断。敏感性、特异性、阳性预测值、阴性预测值和准确性分别为83%、100%、100%、91.6%和94%。最常见的活检部位是胰腺（68%）。EUS-FNA最准确的部位是食管，13/13（100%），其次是胰腺（89.6%）。EUS-FNA对腹部淋巴结的诊断价值最低（70.5%）。在FNA和随访后，发现8例假阴性肿瘤病例（3%），而7.5%的样本仍缺乏明确诊断。讨论。质量控制表明，通过以下方式可能进一步提高EUS-FNA的诊断准确性：（1）从可疑病变处多取几次FNA穿刺样本；（2）优化针具选择；（3）在学习曲线期间配备经验丰富的超声内镜医师；（4）在操作过程中有细胞病理学家在场。质量控制还发现了可纠正的报告错误。总之，质量控制研究对于识别薄弱环节从而提高EUS-FNA的有效性具有重要价值。
