超声内镜引导下细针抽吸检测腹膜癌病：对分期和可切除性的影响（附有视频）。

Detection of peritoneal carcinomatosis by EUS fine-needle aspiration: impact on staging and resectability (with videos).

机构信息

Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

出版信息

Gastrointest Endosc. 2015 May;81(5):1215-24. doi: 10.1016/j.gie.2014.10.028. Epub 2015 Feb 7.

DOI:10.1016/j.gie.2014.10.028

PMID:25660979

Abstract

BACKGROUND

Peritoneal carcinomatosis (PC) greatly affects cancer staging and resectability.

OBJECTIVE

To compare the PC detection rate by using EUS and noninvasive imaging and to determine the impact on staging and resectability.

DESIGN

Retrospective study.

SETTING

Single tertiary-care referral center.

PATIENTS

A prospectively maintained EUS database was reviewed to identify patients who underwent EUS-guided FNA (EUS-FNA) of a peritoneal anomaly. Findings were compared with a strict criterion standard that incorporated cytohistologic, radiologic, and clinical data.

INTERVENTION

EUS-FNA of a peritoneal anomaly.

MAIN OUTCOME MEASUREMENTS

Safety and diagnostic yield.

RESULTS

Of 106 patients, a criterion standard was available in 98 (39 female patients; median age, 65 years). The sensitivity, specificity, and accuracy of EUS-FNA versus CT/magnetic resonance imaging (MRI) was 91% versus 28%, 100% versus 85%, and 94% versus 47%, respectively. In newly diagnosed cancer patients, peritoneal FNA upstaged 17 patients (23.6%). Of 32 patients deemed resectable by pre-EUS CT/MRI, 15 (46.9%) were deemed unresectable based solely on peritoneal FNA. The odds of FNA changing the resectability status remained highly significant after adjustment for cancer type, time between CT/MRI and EUS-FNA, and the quality of CT/MRI. The malignant appearance of the peritoneal anomaly but not the presence of ascites on EUS predicted a positive FNA finding (odds ratio 2.56; 95% confidence interval, 1.23-5.4 and odds ratio 0.83; 95% confidence interval, 0.4-1.8, respectively). There were 3 adverse events among 4 patients. Two of the patients developed abdominal pain and one each hypertensive urgency and pancreatitis.

LIMITATIONS

Retrospective design, single-center, bias toward EUS as a diagnostic test.

CONCLUSION

Peritoneal EUS-FNA appears to safely detect radiographically occult PC and improve cancer staging and patient care.

摘要

背景

腹膜癌病（PC）极大地影响癌症分期和可切除性。

目的

比较 EUS 和非侵入性成像检测 PC 的检出率，并确定其对分期和可切除性的影响。

设计

回顾性研究。

设置

单中心三级转诊中心。

患者

回顾性分析前瞻性维护的 EUS 数据库，以确定接受 EUS 引导下细针抽吸活检（EUS-FNA）的腹膜异常患者。将这些发现与包含细胞组织学、影像学和临床数据的严格标准进行比较。

干预措施

EUS-FNA 对腹膜异常进行检查。

主要观察指标

安全性和诊断率。

结果

在 106 例患者中，98 例（39 例女性患者；中位年龄 65 岁）有明确的标准。EUS-FNA 与 CT/磁共振成像（MRI）相比的灵敏度、特异性和准确性分别为 91%比 28%、100%比 85%和 94%比 47%。在新诊断的癌症患者中，腹膜 FNA 使 17 例患者（23.6%）分期升高。在 32 例根据术前 EUS CT/MRI 被认为可切除的患者中，仅根据腹膜 FNA 就有 15 例（46.9%）被认为不可切除。在调整了癌症类型、CT/MRI 和 EUS-FNA 之间的时间以及 CT/MRI 的质量后，FNA 改变可切除性状态的可能性仍然具有高度显著性。腹膜异常的恶性外观而不是 EUS 上腹水的存在预测了阳性 FNA 发现（优势比 2.56；95%置信区间为 1.23-5.4 和优势比 0.83；95%置信区间为 0.4-1.8，分别）。在 4 名患者中有 3 例出现不良事件。其中 2 例出现腹痛，1 例出现高血压急症和胰腺炎。