Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States.
Division of Gastroenterology, Department of Medicine, Royal Prince Alfred Hospital, Sydney, Australia.
Endoscopy. 2018 May;50(5):497-504. doi: 10.1055/s-0043-122381. Epub 2017 Dec 22.
Standard endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) procedures involve use of no-suction or suction aspiration techniques. A new aspiration method, the stylet slow-pull technique, involves slow withdrawal of the needle stylet to create minimum negative pressure. The aim of this study was to compare the sensitivity of EUS-FNA using stylet slow-pull or suction techniques for malignant solid pancreatic lesions using a standard 22-gauge needle.
Consecutive patients presenting for EUS-FNA of pancreatic mass lesions were randomized to the stylet slow-pull or suction techniques using a 22-gauge needle. Both techniques were standardized for each pass until an adequate specimen was obtained, as determined by rapid on-site cytology examination. Patients were crossed over to the alternative technique after four nondiagnostic passes.
Of 147 patients screened, 121 (mean age 64 ± 13.8 years) met inclusion criteria and were randomized to the stylet slow-pull technique (n = 61) or the suction technique (n = 60). Technical success rates were 96.7 % and 98.3 % in the slow-pull and suction groups, respectively ( > 0.99). The sensitivity for malignancy of EUS-FNA was 82 % in the slow-pull group and 69 % in the suction group ( = 0.10). The first-pass diagnostic rate (42.6 % vs. 38.3 %; = 0.71), acquisition of core tissue (60.6 % vs. 46.7 %; = 0.14), and the median (range) number of passes to diagnosis (2 1 2 3 vs. 1 1 2; = 0.71) were similar in the slow-pull and suction groups, respectively.
The stylet slow-pull and suction techniques both offered high and comparable diagnostic sensitivity with a mean of 2 passes required for diagnosis of solid pancreatic lesions. The endosonographer may choose either technique during FNA.
标准的内镜超声引导下细针抽吸（EUS-FNA）操作包括使用无抽吸或抽吸抽吸技术。一种新的抽吸方法，即针芯缓慢拉拔技术，涉及缓慢拔出针芯以产生最小的负压。本研究的目的是比较使用标准 22 号针的针芯缓慢拉拔或抽吸技术对恶性实体胰腺病变进行 EUS-FNA 的敏感性。
连续就诊于 EUS-FNA 胰腺肿块病变的患者被随机分为针芯缓慢拉拔或抽吸技术组，使用 22 号针。两种技术在每个通过时都进行了标准化，直到通过快速现场细胞学检查获得足够的标本。如果四次诊断性穿刺均未获得诊断，则患者将交叉至另一种技术。
在筛选的 147 名患者中，121 名（平均年龄 64±13.8 岁）符合纳入标准，并被随机分为针芯缓慢拉拔技术组（n=61）或抽吸技术组（n=60）。在缓慢拉拔组和抽吸组中，技术成功率分别为 96.7%和 98.3%（>0.99）。EUS-FNA 对恶性肿瘤的敏感性在缓慢拉拔组为 82%，在抽吸组为 69%（=0.10）。首次通过诊断率（42.6%对 38.3%；=0.71）、获取核心组织（60.6%对 46.7%；=0.14）和中位数（范围）诊断所需的穿刺次数（2 1 2 3 对 1 1 2；=0.71）在缓慢拉拔组和抽吸组中相似。
针芯缓慢拉拔和抽吸技术都提供了高且相当的诊断敏感性，平均需要 2 次穿刺即可诊断实体胰腺病变。在 FNA 过程中，超声内镜医师可以选择任意一种技术。
