比较内镜超声引导下细针抽吸时的毛细血管与抽吸技术：初步报告。

Comparison of capillary versus aspiration technique in endoscopic ultrasound-guided fine-needle aspiration: A preliminary report.

机构信息

San Raffaele Scientific Institute, Milan, Italy.

出版信息

Endosc Ultrasound. 2014 Apr;3(Suppl 1):S7-8.

PMID:26425535

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4569935/

Abstract

INTRODUCTION

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used to diagnose pancreatic malignancies. Different EUS-FNA techniques have been described to improve sample quality. Recently, a new technique, using capillarity, has been proposed.

AIM

To assess the quality of cytological samples, comparing two different FNA techniques, in order to optimize tissue acquisition.

METHODS

All consecutive patients with solid pancreatic lesions, requiring an EUS-FNA, were included in the study between July and September 2013. All procedures were done under deep sedation. FNA was performed using a 25 gauge needle, using both capillary and aspiration technique. Patients were randomized to undergo firstly one or the other technique. Samples were evaluated "on site" by expert cytotechnologist. An expert cytopathologist, blinded for the technique used, reviewed the slides, for final diagnosis and assessed sampling quality. Quality of samples was evaluated through the assessment of the amount of blood, cellularity, tumoral versus normal cells ratio and adequacy for final diagnosis. Data were analyzed with Student's t-test and Chi-square test, assuming a significant P value of 0.05.

RESULTS

A total of 30 consecutive patients (19 M, mean age 67.8 years) with an EUS finding of pancreatic solid lesion were included in the study. Cytological final diagnosis was adenocarcinoma in 25/30 (83.3%) cases, neuroendocrine tumor 1/30 (3.3%), intraductal papillary mucosal neoplasms with high-grade dysplasia 2/30 (6.7%), gastrointestinal stromal tumor in 1/30 (3.3%) and negative for malignant cells 1/30 (3.3%). The difference between the overall blood amount score per technique was not statistically significant (P = 0.61) as well as the cellularity score (P = 0.08). In 13/30 patients (43%) the two techniques reported concordant T/N ratio. In 6/30 patients (20%) final diagnosis was achieved only by capillary obtained smears. In 1/30 patients (3.3%) the diagnosis was done with aspiration. In the remnant, the ratio between the two techniques was similar. Adequacy was reached in 24/30 (80%) with aspiration and 29/30 (97%) with capillary technique (P = 0.04).

CONCLUSIONS

Aspiration and capillary sampling techniques provided similar results in cellularity and blood amount. However, adequacy rate was significantly superior in capillary technique. Furthermore, in 20% of cases, final diagnosis was achieved only with capillary samples.

摘要

简介

内镜超声引导下细针抽吸术（EUS-FNA）广泛用于诊断胰腺恶性肿瘤。为了提高样本质量，已经描述了不同的 EUS-FNA 技术。最近，提出了一种使用毛细作用的新技术。

目的

评估两种不同的 FNA 技术的细胞学样本质量，以优化组织采集。

方法

所有需要 EUS-FNA 的胰腺实性病变连续患者均于 2013 年 7 月至 9 月期间纳入研究。所有操作均在深度镇静下进行。使用 25 号针进行 FNA，同时使用毛细和抽吸技术。患者随机首先进行一种或另一种技术。专家细胞技术人员在现场评估样本。一位专家细胞病理学家对技术使用情况进行了盲法，对幻灯片进行了回顾，以进行最终诊断和评估采样质量。通过评估血液量、细胞数量、肿瘤与正常细胞的比例以及最终诊断的充分性来评估样本质量。使用 Student's t 检验和卡方检验进行数据分析，假设 P 值显著为 0.05。

结果

共有 30 例连续患者（19 例男性，平均年龄 67.8 岁），EUS 发现胰腺实性病变，纳入研究。细胞学最终诊断为腺癌 25/30（83.3%）例，神经内分泌肿瘤 1/30（3.3%）例，高级别异型增生的导管内乳头状黏膜肿瘤 2/30（6.7%）例，胃肠道间质瘤 1/30（3.3%）例，恶性细胞阴性 1/30（3.3%）例。两种技术的总体血液量评分差异无统计学意义（P = 0.61），细胞数量评分也无统计学意义（P = 0.08）。在 30 例患者中有 13 例（43%）两种技术报告了一致的 T/N 比。在 6 例患者中有（20%）最终诊断仅通过毛细管获得的涂片得出。在 1 例患者中有（3.3%）通过抽吸获得诊断。其余的，两种技术之间的比值相似。抽吸获得 24/30（80%）例和毛细管技术获得 29/30（97%）例达到了充分性（P = 0.04）。