Jeong Seok Hoo, Yoon Hyun Hwa, Kim Eui Joo, Kim Yoon Jae, Kim Yeon Suk, Cho Jae Hee
aDepartment of Internal Medicine, Catholic Kwandong University International St. Mary's Hospital bDepartment of Internal Medicine, Gachon University School of Medicine, Gil Medical Center, Incheon, Korea.
Medicine (Baltimore). 2017 Jan;96(2):e5782. doi: 10.1097/MD.0000000000005782.
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the accurate diagnostic method for pancreatic masses and its accuracy is affected by various FNA methods and EUS equipment. Therefore, we aimed to elucidate the instrumental and methodologic factors for determining the diagnostic yield of EUS-FNA for pancreatic solid masses without an on-site cytopathology evaluation.We retrospectively reviewed the medical records of 260 patients (265 pancreatic solid masses) who underwent EUS-FNA. We compared historical conventional EUS groups with high-resolution imaging devices and finally analyzed various factors affecting EUS-FNA accuracy.In total, 265 pancreatic solid masses of 260 patients were included in this study. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of EUS-FNA for pancreatic solid masses without on-site cytopathology evaluation were 83.4%, 81.8%, 100.0%, 100.0%, and 34.3%, respectively. In comparison with conventional image group, high-resolution image group showed the increased accuracy, sensitivity and specificity of EUS-FNA (71.3% vs 92.7%, 68.9% vs 91.9%, and 100% vs 100%, respectively). On the multivariate analysis with various instrumental and methodologic factors, high-resolution imaging (P = 0.040, odds ratio = 3.28) and 3 or more needle passes (P = 0.039, odds ratio = 2.41) were important factors affecting diagnostic yield of pancreatic solid masses.High-resolution imaging and 3 or more passes were the most significant factors influencing diagnostic yield of EUS-FNA in patients with pancreatic solid masses without an on-site cytopathologist.
内镜超声引导下细针穿刺活检（EUS-FNA）是诊断胰腺肿块的准确方法，其准确性受多种FNA方法和EUS设备的影响。因此，我们旨在阐明在没有现场细胞病理学评估的情况下，决定EUS-FNA对胰腺实性肿块诊断率的仪器和方法学因素。我们回顾性分析了260例接受EUS-FNA患者（265个胰腺实性肿块）的病历。我们将使用高分辨率成像设备的传统EUS组进行对比，并最终分析影响EUS-FNA准确性的各种因素。本研究共纳入260例患者的265个胰腺实性肿块。在没有现场细胞病理学评估的情况下，EUS-FNA对胰腺实性肿块的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为83.4%、81.8%、100.0%、100.0%和34.3%。与传统图像组相比，高分辨率图像组的EUS-FNA准确性、敏感性和特异性均有所提高（分别为71.3%对92.7%、68.9%对91.9%、100%对100%）。在对各种仪器和方法学因素进行多变量分析时，高分辨率成像（P = 0.040，比值比 = 3.28）和3次或更多次穿刺（P = 0.039，比值比 = 2.41）是影响胰腺实性肿块诊断率的重要因素。高分辨率成像和3次或更多次穿刺是影响没有现场细胞病理学家的胰腺实性肿块患者EUS-FNA诊断率的最重要因素。
