El Haddad Rana, Barret Maximilien, Beuvon Frédéric, Grabar Sophie, Leblanc Sarah, Terris Benoit, Coriat Romain, Chaussade Stanislas, Prat Frédéric
Departments of aGastroenterology bPathology cBiostatistics and Epidemiology, Cochin Hospital, Assistance Publique - Hopitaux de Paris dSchool of Medicine, Paris Descartes University, Paris, France.
Eur J Gastroenterol Hepatol. 2016 Aug;28(8):911-6. doi: 10.1097/MEG.0000000000000638.
Endoscopic ultrasound-guided sampling is used routinely for the diagnosis of solid pancreatic masses. We aimed to compare the standard suction technique with the recently described 'slow-pull' technique.
Patients with a solid pancreatic mass of more than 2 cm undergoing endoscopic ultrasound-guided fine needle biopsy with the same endoscopist using a 22 G core biopsy needle were included in the study. Patients had a first suction pass, followed by either another suction pass or a slow-pull pass. The rate of samples contributive to the diagnosis, cellularity, presence of tissue microfragments, and blood contamination were assessed and compared between each pass and each technique.
A total of 98 patients with a lesion diameter of 33.1±10 mm were analyzed. Lesions were adenocarcinomas in 83%, neuroendocrine tumors in 6%, and benign lesions in 11% of the cases. The rate of contributive samples of the first suction pass, the slow-pull pass, and the second suction pass were 96.9, 97.9, and 90.2%, respectively (P=NS). The slow-pull capillary technique, compared with the suction technique, provided samples with better cellularity, higher proportion of representative and tumor cells, and more tissue microfragments (P=0.002, 0.0004, 0.006, and 0.005, respectively).
Endoscopic ultrasound-guided fine needle biopsy sampling of solid pancreatic lesions using the slow-pull technique yielded overall outcomes similar to the standard suction technique in terms of diagnostic performance. However, the slow-pull capillary technique improved the histological quality of the samples, mainly through a higher proportion of tissue microfragments and tumor cells.
内镜超声引导下采样常用于实性胰腺肿块的诊断。我们旨在比较标准抽吸技术与最近描述的“慢拉”技术。
本研究纳入了由同一位内镜医师使用22G活检针进行内镜超声引导下细针穿刺活检的直径超过2厘米的实性胰腺肿块患者。患者先进行首次抽吸穿刺，然后再进行一次抽吸穿刺或慢拉穿刺。评估并比较每次穿刺及每种技术的有助于诊断的样本率、细胞含量、组织微碎片的存在情况和血液污染情况。
共分析了98例病变直径为33.1±10毫米的患者。病例中83%为腺癌，6%为神经内分泌肿瘤，11%为良性病变。首次抽吸穿刺、慢拉穿刺和第二次抽吸穿刺的有助于诊断的样本率分别为96.9%、97.9%和90.2%（P=无显著性差异）。与抽吸技术相比，慢拉毛细管技术提供的样本细胞含量更好，代表性细胞和肿瘤细胞比例更高，组织微碎片更多（分别为P=0.002、0.0004、0.006和0.005）。
在内镜超声引导下对实性胰腺病变进行细针穿刺活检采样时，慢拉技术在诊断性能方面产生的总体结果与标准抽吸技术相似。然而，慢拉毛细管技术提高了样本的组织学质量，主要是通过更高比例的组织微碎片和肿瘤细胞实现的。
