2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka, 569-8686, Japan.
Department of Pathology, Osaka Medical College, Osaka, Japan.
Surg Endosc. 2018 Oct;32(10):4125-4131. doi: 10.1007/s00464-018-6155-7. Epub 2018 Mar 30.
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been established as a method to obtain tissues of various organs. To obtain sufficient tissue has clinical impact to facilitate the diagnosis by clinical pathologists, the assessment and subtyping of various neoplasms, and for further immunohistochemical investigations of tumor type. Recently, a novel 20G core trap with a forward-cutting beveled FNA needle (ProC-F) has become available. The aim of this prospective study was to evaluate the feasibility and diagnostic yield of EUS-FNA for pancreatic lesions using this needle.
In this study, the first puncture was performed using the ProC-F. Only tissue obtained with the first puncture using the ProC-F was used to evaluate diagnostic yield of ProC-F. The second puncture was performed using a 22G standard FNA needle using the same technique as for the first puncture. Second puncture was performed if the endosonographer did not feel that sufficient tissue had not been obtained by first puncture.
Fifty-three consecutive patients who underwent EUS-FNA for pancreatic lesions were prospectively enrolled. The technical success rate of EUS-FNA using the ProC-F was 98.1% (52/53). The rate of adequate tissue obtained by ProC-F was 96.2% (50/52). On the other hand, the rate of adequate tissue obtained by the standard needle was 71.1%. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of the ProC-F and the standard needle were 92.5, 100, 100, 76.9, and 94.0%, and 85.2, 100, 100, 55.6, and 87.5%, respectively. Diagnostic yield of ProC-F about sensitivity (P = 0.027), NPV (P = 0.035), and accuracy (P = 0.004) was significantly higher than of standard needle. Adverse events were not seen in any patients.
Although only tissue obtained by the first puncture was evaluated, the rate of adequate tissue and the histologic diagnostic yield for pancreatic lesions were extremely high using the ProC-F.
内镜超声引导下细针抽吸术（EUS-FNA）已被确立为获取各种器官组织的方法。获得足够的组织对临床病理学家的诊断、各种肿瘤的评估和分型以及进一步的肿瘤类型免疫组织化学研究具有临床影响。最近，一种新型的 20G 核心捕获器和带有前切斜角 FNA 针的 ProC-F 已投入使用。本前瞻性研究的目的是评估使用这种针进行胰腺病变的 EUS-FNA 的可行性和诊断率。
在这项研究中，第一次穿刺使用 ProC-F 进行。仅使用 ProC-F 进行第一次穿刺获得的组织用于评估 ProC-F 的诊断率。如果超声内镜医师感觉第一次穿刺未获得足够的组织，则进行第二次 22G 标准 FNA 针穿刺。
53 例连续接受 EUS-FNA 检查的胰腺病变患者前瞻性入组。使用 ProC-F 进行 EUS-FNA 的技术成功率为 98.1%（52/53）。ProC-F 获得的足够组织率为 96.2%（50/52）。另一方面，标准针获得的足够组织率为 71.1%。ProC-F 和标准针的敏感性、特异性、阴性预测值（NPV）、阳性预测值（PPV）和准确性分别为 92.5%、100%、100%、76.9%和 94.0%，85.2%、100%、100%、55.6%和 87.5%。ProC-F 的诊断率在敏感性（P=0.027）、NPV（P=0.035）和准确性（P=0.004）方面显著高于标准针。在任何患者中均未观察到不良事件。
尽管仅评估了第一次穿刺获得的组织，但 ProC-F 用于胰腺病变时，获得足够组织的比例和组织学诊断率非常高。
