Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Gastrointestin Liver Dis. 2013 Jun;22(2):183-7.
BACKGROUND & AIMS: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is indispensable for the diagnosis of solid pancreatic lesions (SPLs). However, initial attempt of EUS-FNA can be inconclusive. We retrospectively evaluated the ability of repeat EUS-FNA at a tertiary referral hospital to obtain a conclusive cytological diagnosis after the initial inconclusive EUS-FNA results at referring facilities.
We identified patients who had undergone EUS-FNA for SPLs and with inconclusive cytological diagnosis at referring facilities. The diagnostic ability of EUS-FNA was defined as the percentage of cases with conclusive cytological diagnoses out of the total included cases in which initial results had been inconclusive. As a secondary outcome, we conducted sub-group analysis to reveal factors which might have assisted conclusive results at the University of Texas MD Anderson Cancer Center (MDA).
We found 913 patients who underwent EUS-FNA for SPLs between 2005 and 2011. Among them, we recruited 84 patients who met the above criteria. Repeat EUS-FNA had ability to clarify the diagnosis in 82.1 % (69/84). No statistical differences were observed in tumor size (n = 50, 29.8 versus 29.4 mm, P-value = 0.84) and the number of needles passes (n = 40, 4.0 versus 3.4, P-value = 0.1) between outside MDA and MDA. Rapid on-site evaluation was present in less than half of cases outside MDA (n = 33, 42.4 versus 100%, P-value = 0.0001). MDA endosonographers had more years of experience compared to outside MDA (n = 50, 12.9 versus 10 years, P-value = 0.015).
A repeat EUS-FNA for SPLs with initial inconclusive diagnosis at a tertiary referral center establishes a diagnosis in the majority of patients.
内镜超声引导下细针抽吸术（EUS-FNA）对于诊断胰腺实体病变（SPL）是不可或缺的。然而，EUS-FNA 的初次尝试可能无法得出明确的结果。我们回顾性评估了在三级转诊医院对初次 EUS-FNA 结果不明确的患者进行重复 EUS-FNA 以获得明确细胞学诊断的能力。
我们确定了在转诊机构进行 EUS-FNA 检查以诊断 SPL 且初次 EUS-FNA 结果不明确的患者。EUS-FNA 的诊断能力定义为初次结果不明确的总纳入病例中，获得明确细胞学诊断的病例百分比。作为次要结果，我们进行了亚组分析，以揭示在德克萨斯大学 MD 安德森癌症中心（MDA）可能有助于获得明确结果的因素。
我们发现 2005 年至 2011 年间有 913 例患者因 SPL 而行 EUS-FNA 检查。其中，我们招募了符合上述标准的 84 例患者。重复 EUS-FNA 能够明确诊断的比例为 82.1%（69/84）。MDA 外和 MDA 内的肿瘤大小（n=50，29.8 毫米与 29.4 毫米，P 值=0.84）和针数（n=40，4.0 次与 3.4 次，P 值=0.1）无统计学差异。MDA 外的病例中，快速现场评估不到一半（n=33，42.4%与 100%，P 值=0.0001）。MDA 超声内镜医师的经验年限长于 MDA 外（n=50，12.9 年与 10 年，P 值=0.015）。
在三级转诊中心，对初次 EUS-FNA 结果不明确的 SPL 患者进行重复 EUS-FNA 可使大多数患者获得明确诊断。
