Ge Phillip S, Wani Sachin, Watson Rabindra R, Sedarat Alireza, Kim Stephen, Marshall Carrie, Wilson Robert H, Makker Jitin, Mohamadnejad Mehdi, Komanduri Srinadh, Muthusamy V Raman
Pancreas. 2018 Mar;47(3):296-301. doi: 10.1097/MPA.0000000000001003.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely performed for the evaluation of pancreatic masses. We evaluated the performance characteristics of EUS-FNA in obtaining a diagnosis of pancreatic malignancy.
We performed a multicenter study of patients who underwent EUS-FNA for a solid pancreatic mass. Endoscopic ultrasound-guided FNA was standardized using a 25-gauge needle, slow-pull stylet technique for specimen acquisition, and on-site cytopathology. For the primary analysis, only malignant cytology was regarded as positive. A secondary analysis was performed in which malignant and/or suspicious cytology was regarded as positive.
A total of 138 patients underwent EUS-FNA. In the primary analysis, the sensitivity of EUS-FNA for malignancy was 56.7% on first pass, 73.3% on second pass, 83.3% on third pass, 89.2% on fourth pass, and 90.8% on fifth pass, with no increase beyond the fifth pass. In the secondary analysis, the sensitivity was 75.0% on first pass, 89.2% on second pass, 93.3% on third pass, and 95.8% on fourth pass, with no increase beyond the fourth pass. No significant relationship was seen between lesion size and diagnostic yield.
Using a 25-gauge needle, the maximal diagnostic yield of EUS-FNA for a solid pancreatic mass is reached after 4 needle passes.
内镜超声引导下细针穿刺抽吸术（EUS-FNA）广泛应用于胰腺肿块的评估。我们评估了EUS-FNA在诊断胰腺恶性肿瘤方面的性能特征。
我们对因实性胰腺肿块接受EUS-FNA的患者进行了一项多中心研究。使用25号针、慢拉针芯技术获取标本以及现场细胞病理学对内镜超声引导下的FNA进行标准化。在初步分析中，仅恶性细胞学被视为阳性。进行了二次分析，其中恶性和/或可疑细胞学被视为阳性。
共有138例患者接受了EUS-FNA。在初步分析中，EUS-FNA对恶性肿瘤的首次穿刺敏感性为56.7%，第二次穿刺为73.3%，第三次穿刺为83.3%，第四次穿刺为89.2%，第五次穿刺为90.8%，第五次穿刺后无增加。在二次分析中，首次穿刺敏感性为75.0%，第二次穿刺为89.2%，第三次穿刺为93.3%，第四次穿刺为95.8%，第四次穿刺后无增加。未发现病变大小与诊断率之间存在显著关系。
使用25号针，EUS-FNA对实性胰腺肿块的最大诊断率在4次针吸后达到。
