Krishna Somashekar G, Bhattacharya Abhik, Li Feng, Ross William A, Ladha Harshad, Porter Kyle, Atiq Muslim, Bhutani Manoop S, Lee Jeffrey H
From the *Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX; †Department of Gastroenterology, Hepatology, and Nutrition, and ‡Department of Biostatistics, The Ohio State University, Columbus, OH.
Pancreas. 2016 Mar;45(3):394-400. doi: 10.1097/MPA.0000000000000488.
To identify factors differentiating pancreatic neuroendocrine tumors (PNETs) from non-PNET neoplastic solid pancreatic lesions (SPLs) and assess the accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).
This is a retrospective study at a tertiary center of consecutive patients referred for EUS from 2004 to 2011. The main outcomes were pretest predictors and accuracy of EUS-FNA for diagnosis of PNET.
Among a total of 1108 EUS-FNAs for pancreatic lesions, 672 patients (PNET = 91, non-PNET neoplastic-SPLs = 581) had neoplastic-SPLs. The sensitivity, specificity, and accuracy of EUS-FNA for diagnosis of PNETs were 98.9%, 100%, and 99.9%, respectively. The mean needle-passes were 3.0/patient. The EUS volume (mean/year per endosonographer) in preceding 3 years significantly correlated with fewer needle passes (rs: [-0.26]; P = 0.02).Multivariate analysis demonstrated that patients with PNET when compared to non-PNET neoplastic-SPLs were younger (odds ratio [OR], 3.23; 95% confidence interval [95% CI], 1.19-9.09; P = 0.001), have 2 or more pancreatic lesions (OR, 5.63; 95% CI, 1.74-18.2; P = 0.005), and lower CA 19-9 values (OR, 10.0; 95% CI, 3.13-33.3; P = 0.001). Further, PNETs were less likely to have weight loss (OR, 0.40; 95% CI, 0.17-0.90; P = 0.03), current smoking (OR, 0.47; 95% CI, 0.22-0.98; P < 0.05), pancreatic ductal dilation (OR, 0.28; 95% CI, 0.13-0.60; P = 0.002), or imaging evidence of arterial invasion (OR, 0.22; 95% CI, 0.07-0.71; P = 0.01).
Although pre-FNA findings can reliably characterize, EUS-FNA is highly accurate for the diagnosis of PNETs.
确定区分胰腺神经内分泌肿瘤（PNETs）与非PNET的胰腺肿瘤性实性病变（SPLs）的因素，并评估内镜超声引导下细针穿刺活检（EUS-FNA）的准确性。
这是一项在三级中心进行的回顾性研究，纳入了2004年至2011年连续接受EUS检查的患者。主要观察指标为EUS-FNA诊断PNET的预测因素及准确性。
在总共1108例针对胰腺病变的EUS-FNA检查中，672例患者（PNET = 91例，非PNET肿瘤性SPLs = 581例）患有肿瘤性SPLs。EUS-FNA诊断PNET的敏感性、特异性和准确性分别为98.9%、100%和99.9%。平均每位患者穿刺针数为3.0次。前3年内每位超声内镜医师的EUS检查量（平均每年）与穿刺针数减少显著相关（rs：[-0.26]；P = 0.02）。多因素分析表明，与非PNET肿瘤性SPLs相比，PNET患者更年轻（比值比[OR]，3.23；95%置信区间[95%CI]，1.19 - 9.09；P = 0.001），有2个或更多胰腺病变（OR，5.63；95%CI，1.74 - 18.2；P = 0.005），且CA 19-9值较低（OR，10.0；95%CI，3.13 - 33.3；P = 0.001）。此外，PNET患者体重减轻的可能性较小（OR，0.40；95%CI，0.17 - 0.90；P = 0.03），当前吸烟的可能性较小（OR，0.47；95%CI，0.22 - 0.98；P < 0.05），胰腺导管扩张的可能性较小（OR，0.28；95%CI，0.13 - 0.60；P = 0.002），或有动脉侵犯的影像学证据的可能性较小（OR，0.22；95%CI，0.07 - 0.71；P = 0.01）。
尽管FNA前的检查结果可可靠地进行特征描述，但EUS-FNA对PNET的诊断具有高度准确性。
