Digestive Endoscopy Unit, Catholic University, Largo A. Gemelli 8, 00168, Rome, Italy,
Surg Endosc. 2013 Oct;27(10):3733-8. doi: 10.1007/s00464-013-2957-9. Epub 2013 May 4.
The option of obtaining tissue samples for histological examination during endoscopic ultrasound (EUS) has theoretical and practical advantages over cytology alone. The aim of this study was to evaluate the feasibility, yield, and diagnostic accuracy of a new EUS 22-G fine-needle biopsy (FNB) device in patients with solid pancreatic masses in a multicenter, prospective study.
All consecutive patients who underwent EUS-guided fine-needle biopsy (EUS-FNB) using a newly developed 22-G FNB needle between September 2010 and October 2010 were enrolled in the study. The EUS-FNB technique was standardized among the participating endoscopists. Only a single needle pass was performed.
A total of 61 patients (35 males, mean age 64.2 ± 12.4 years) with solid pancreatic masses with a mean size of 32.4 ± 8.5 mm (range 13-90 mm) participated. EUS-FNB was performed through the duodenum in 35 cases (57.4 %) and was technically feasible in all but one of the 61 (98.4 %) patients without complications. Tissue samples for histological examination were obtained from 55 patients (90.2 %) and were deemed adequate in 54 of the cases (88.5 %). The diagnoses established by EUS-FNB were adenocarcinoma (39 patients), neuroendocrine tumors (5), chronic focal pancreatitis (5), sarcoma (2), lymphoma (1), acinar cellular tumor (1), and pancreatic metastasis from renal cell carcinoma (1). In an intention-to-treat (ITT) analysis, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the histologic diagnosis of a pancreatic mass were 87.5, 100, 100, 41.7, and 88.5 %, respectively.
EUS-FNB was technically feasible in 98 % of patients with a solid pancreatic mass. A suitable sample for histological evaluation was obtained in 88.5 % of the cases after only one single needle pass. The apparently low negative predictive value is likely to be improved by increasing the number of needle passes.
内镜超声 (EUS) 下获取组织样本进行组织学检查的选择在理论和实践上优于单独细胞学检查。本研究的目的是在一项多中心前瞻性研究中评估一种新的 EUS 22-G 细针活检 (FNB) 装置在胰腺实性肿块患者中的可行性、产量和诊断准确性。
2010 年 9 月至 2010 年 10 月期间，所有连续接受新开发的 22-G FNB 针 EUS 引导下细针活检 (EUS-FNB) 的患者均纳入本研究。参与的内镜医生之间标准化了 EUS-FNB 技术。仅进行一次单一的穿刺。
共有 61 例男性患者（平均年龄 64.2±12.4 岁）接受了胰腺实性肿块的 EUS-FNB 检查，肿块平均大小为 32.4±8.5mm（范围 13-90mm）。EUS-FNB 通过十二指肠进行 35 例（57.4%），除 1 例（98.4%）患者外，所有患者均能顺利进行操作，且无并发症。55 例（90.2%）患者获得了用于组织学检查的组织样本，其中 54 例（88.5%）认为足够。EUS-FNB 诊断为腺癌（39 例）、神经内分泌肿瘤（5 例）、慢性局灶性胰腺炎（5 例）、肉瘤（2 例）、淋巴瘤（1 例）、腺泡细胞肿瘤（1 例）和肾细胞癌胰腺转移（1 例）。在意向治疗 (ITT) 分析中，胰腺肿块组织学诊断的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 87.5%、100%、100%、41.7%和 88.5%。
EUS-FNB 在 98%的胰腺实性肿块患者中是可行的。仅进行一次单一穿刺后，88.5%的病例获得了适合组织学评估的样本。通过增加穿刺次数，阴性预测值可能会提高。
