Uehara Hiroyuki, Sueyoshi Hironari, Takada Ryoji, Fukutake Nobuyasu, Katayama Kazuhiro, Ashida Reiko, Ioka Tatsuya, Takenaka Akemi, Nagata Shigenori, Tomita Yasuhiko
Department of Hepatobiliary and Pancreatic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Department of Hepatobiliary and Pancreatic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Pancreatology. 2015 Jul-Aug;15(4):392-6. doi: 10.1016/j.pan.2015.04.005. Epub 2015 May 1.
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is accurate in cytological diagnosis of pancreatic lesions. Our aim was to determine optimal number of needle passes in EUS-FNA for pancreatic lesions without onsite cytopathologist, who is not routinely available to participate in the procedure.
Results of all needle passes in EUS-FNAs for 117 pancreatic neoplasms in 115 patients were reviewed retrospectively. Factors that required 2 or more needle passes for correct diagnosis were identified by multivariate logistic regression analysis. In each lesion group defined by the factors that required 2 or more passes and were known at the time of EUS-FNA, number of needle passes was regarded as optimal when an increase in diagnostic sensitivity by an additional needle pass did not reach 10%.
Size of 15 mm or less (OR 4.58, 95% CI 1.70-12.3, P < 0.01), location of head (OR 5.02, 95% CI 1.82-13.9, P < 0.01), and neuroendocrine tumor (NET) (OR 5.04, 95% CI 1.38-18.4, P = 0.01) independently required 2 or more needle passes. Optimal numbers of needle passes for lesions of 15 mm or less in the head, those of more than 15 mm in the head, those of 15 mm or less in the body or tail, and those of more than 15 mm in the body or tail were 3, 2, 2, and 1, respectively. When these numbers of needle passes were performed, 93% of pancreatic lesions were correctly diagnosed.
Optimal numbers of needle passes in EUS-FNA for pancreatic lesions without onsite cytopathologist were between 1 and 3.
内镜超声引导下细针穿刺抽吸术（EUS-FNA）在胰腺病变的细胞学诊断中具有准确性。我们的目的是确定在没有现场细胞病理学家参与（细胞病理学家通常不参与该操作）的情况下，EUS-FNA对胰腺病变进行穿刺的最佳次数。
回顾性分析115例患者117个胰腺肿瘤的EUS-FNA所有穿刺结果。通过多因素逻辑回归分析确定正确诊断需要2次或更多次穿刺的因素。在由需要2次或更多次穿刺且在EUS-FNA时已知的因素所定义的每个病变组中，当增加一次穿刺导致诊断敏感性的提高未达到10%时，穿刺次数被视为最佳。
直径15mm或更小（比值比4.58，95%置信区间1.70-12.3，P<0.01）、位于胰头（比值比5.02，95%置信区间1.82-13.9，P<0.01）以及神经内分泌肿瘤（NET）（比值比5.04，95%置信区间1.38-18.4，P=0.01）独立地需要2次或更多次穿刺。胰头直径15mm或更小的病变、胰头直径大于15mm的病变、胰体或胰尾直径15mm或更小的病变以及胰体或胰尾直径大于15mm的病变的最佳穿刺次数分别为3次、2次、2次和1次。当进行这些穿刺次数时，93%的胰腺病变被正确诊断。
在没有现场细胞病理学家的情况下进行EUS-FNA时，胰腺病变的最佳穿刺次数为1至3次。
