Weston Brian R, Bhutani Manoop S
Dr. Weston is an Assistant Professor and Dr. Bhutani is a Professor in the Department of Gastroenterology, Hepatology, and Nutrition at the University of Texas MD Anderson Cancer Center in Houston, Texas.
Gastroenterol Hepatol (N Y). 2013 Jun;9(6):352-63.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has a higher diagnostic accuracy for pancreatic cancer than other techniques. This article will review the current advances and considerations for optimizing diagnostic yield for EUS-guided sampling of solid pancreatic lesions. Preprocedural considerations include patient history, confirmation of appropriate indication, review of imaging, method of sedation, experience required by the endoscopist, and access to rapid on-site cytologic evaluation. New EUS imaging techniques that may assist with differential diagnoses include contrast-enhanced harmonic EUS, EUS elastography, and EUS spectrum analysis. FNA techniques vary, and multiple FNA needles are now commercially available; however, neither techniques nor available FNA needles have been definitively compared. The need for suction depends on the lesion, and the need for a stylet is equivocal. No definitive endosonographic finding can predict the optimal number of passes for diagnostic yield. Preparation of good smears and communication with the cytopathologist are essential to optimize yield.
内镜超声引导下细针穿刺活检（EUS-FNA）对胰腺癌的诊断准确性高于其他技术。本文将综述当前在优化EUS引导下实性胰腺病变采样诊断率方面的进展和注意事项。术前考虑因素包括患者病史、确认适应证是否合适、影像学检查回顾、镇静方法、内镜医师所需经验以及能否进行快速现场细胞学评估。有助于鉴别诊断的新型EUS成像技术包括对比增强谐波EUS、EUS弹性成像和EUS频谱分析。FNA技术各不相同，目前市场上有多种FNA针可供选择；然而，尚未对技术和可用的FNA针进行明确比较。是否需要抽吸取决于病变情况，而是否需要针芯尚无定论。没有明确的内镜超声表现能够预测获得诊断率的最佳穿刺次数。制备良好的涂片以及与细胞病理学家沟通对于优化诊断率至关重要。
