多中心、前瞻性、交叉试验，比较敲门法与传统方法用于实性胰腺肿块的超声内镜引导下细针穿刺活检（附视频）
Multicenter, prospective, crossover trial comparing the door-knocking method with the conventional method for EUS-FNA of solid pancreatic masses (with videos).
作者信息
Mukai Shuntaro, Itoi Takao, Ashida Reiko, Tsuchiya Takayoshi, Ikeuchi Nobuhito, Kamada Kentaro, Tanaka Reina, Umeda Junko, Tonozuka Ryosuke, Fukutake Nobuyasu, Hoshi Koki, Moriyasu Fuminori, Gotoda Takuji, Irisawa Atsushi
机构信息
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Department of Hepatobiliary and Pancreato-oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan.
出版信息
Gastrointest Endosc. 2016 Jun;83(6):1210-7. doi: 10.1016/j.gie.2015.10.025. Epub 2015 Oct 30.
BACKGROUND AND AIMS
There are currently no prospective, controlled trials of needle puncture speed in EUS-guided FNA (EUS-FNA). In this study, we prospectively evaluated the accuracy of histological diagnosis and the tissue acquisition rate of EUS-FNA by using the door-knocking method (DKM) with a standard 22-gauge needle.
METHODS
From November 2013 to August 2014, 82 patients who had solid pancreatic masses underwent EUS-FNA in which the conventional method (CM) and DKM with 2 respective passes in turn were used. The primary outcomes of this study were the accuracy of histological diagnosis and the rates of tissue acquisition in 2 FNA procedures by using these 2 methods.
RESULTS
Although the successful tissue acquisition rate for histology was not significantly different with the DKM and CM (91.5% vs 89.0%, P = .37), the high cellularity tissue acquisition rate for histology with the DKM was significantly superior to that with the CM (54.9% vs 41.5%, P = .03). However, adequate quality rate and accuracy were not different in the DKM and CM (78.0% vs 80.5%, P = .42 and 76.8% vs 78.0%, P = .50, respectively). In the transgastric puncture group, although the adequate quality rate and accuracy were similar in the DKM and CM (84.1% vs 79.4%, P = .30 and 84.1% vs 76.2%, P = .11, respectively), the tissue acquisition rate tended to be higher with the DKM than the CM (93.7% vs 85.7%, P = .06). Moreover, the high cellularity tissue acquisition rate was significantly better with the DKM than the CM (63.5% vs 39.7%, P = .002). On the other hand, in the transduodenal puncture group, although the tissue acquisition rate was similar with the DKM and CM (84.2% vs 100%, P = .13), the adequate quality rate and accuracy were significantly lower with the DKM than with the CM (57.9% vs 84.2%, P = .03 and 52.6% vs 84.2%, P = .02, respectively).
CONCLUSION
EUS-FNA by using a 22-gauge needle with the DKM did not improve the accuracy of histological diagnosis, but enabled acquisition of a larger amount of tissue specimen by using transgastric puncture. (
TRIAL REGISTRATION
http://www.umin.ac.jp/english/: UMIN000012127.).
背景与目的
目前尚无关于超声内镜引导下细针穿刺活检（EUS-FNA）时穿刺针速度的前瞻性对照试验。在本研究中，我们前瞻性评估了使用标准22G穿刺针采用敲门法（DKM）进行EUS-FNA的组织学诊断准确性和组织获取率。
方法
2013年11月至2014年8月，82例胰腺实性肿块患者接受EUS-FNA，依次采用传统方法（CM）和DKM各穿刺2次。本研究的主要结局是使用这两种方法进行2次FNA操作时的组织学诊断准确性和组织获取率。
结果
尽管DKM和CM的组织学成功获取率无显著差异（91.5%对89.0%，P = 0.37），但DKM的组织学高细胞率组织获取率显著优于CM（54.9%对41.5%，P = 0.03）。然而，DKM和CM的标本质量合格率及准确性无差异（分别为78.0%对80.5%，P = 0.42；76.8%对78.0%，P = 0.50）。在经胃穿刺组，尽管DKM和CM的标本质量合格率及准确性相似（分别为84.1%对79.4%，P = 0.30；84.1%对76.2%，P = 0.11），但DKM的组织获取率有高于CM的趋势（93.7%对85.7%，P = 0.06）。此外，DKM的高细胞率组织获取率显著优于CM（63.5%对39.7%，P = 0.002）。另一方面，在经十二指肠穿刺组，尽管DKM和CM的组织获取率相似（84.2%对100%，P = 0.13），但DKM的标本质量合格率及准确性显著低于CM（分别为57.9%对84.2%，P = 0.03；52.6%对84.2%，P = 0.02）。
结论
使用22G穿刺针采用DKM进行EUS-FNA并未提高组织学诊断准确性，但经胃穿刺时能获取更多组织标本。（试验注册号：http://www.umin.ac.jp/english/: UMIN000012127.）
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