Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
Pancreatology. 2019 Jan;19(1):191-195. doi: 10.1016/j.pan.2018.12.001. Epub 2018 Dec 2.
BACKGROUND/OBJECTIVES: A clear criterion for terminating endoscopic ultrasound fine needle aspiration (EUS-FNA) without rapid on-site evaluation (ROSE) has not been established. However, a possible solution includes gross visual inspection (GVI) of the sample obtained with EUS-FNA. We performed a retrospective study to elucidate the efficacy of GVI for the diagnostic yield of EUS-FNA.
Patients who underwent EUS-FNA of a pancreatic mass using a standard 22-G needle from January 2017 to December 2017 were included in the study. At least two punctures were performed for each patient, and GVI was performed for each pass by endoscopists. The correlation between GVI and pathological findings were investigated per needle pass for the first two passes. Regarding GVI, we evaluated the presence of a visible core (with or without) and the sample quantity (large or small).
We evaluated 126 EUS-FNA specimens and analyzed 252 needle passes. A final diagnosis of malignancy was made for 119 patients (94%). Accuracy rates were 92.5% with a visible core and 70.0% without a visible core (p < 0.01), and 85.2% for large sample quantities and 70.2% for small sample quantities (p < 0.01). Univariate analysis indicated that the presence of a visible core and large sample quantity were associated with accuracy. Multivariate analysis indicated that only the presence of a visible core was significant.
GVI can predict the correct diagnosis when ROSE is unavailable. Evaluating the presence of a visible core is more sensitive than assessing the quantity of the sample obtained.
背景/目的：目前尚未确立一种在无快速现场评估（ROSE）的情况下终止内镜超声细针抽吸（EUS-FNA）的明确标准。然而，一种可能的解决方案包括对 EUS-FNA 获得的样本进行大体目视检查（GVI）。我们进行了一项回顾性研究，以阐明 GVI 对 EUS-FNA 诊断产量的效果。
本研究纳入了 2017 年 1 月至 2017 年 12 月期间使用标准 22-G 针进行胰腺肿块 EUS-FNA 的患者。每位患者至少进行两次穿刺，且内镜医师对每次穿刺都进行 GVI。按针次对前两次穿刺的 GVI 与病理结果的相关性进行了研究。关于 GVI，我们评估了可见核心的存在（有或无）和样本量（大或小）。
我们评估了 126 个 EUS-FNA 标本，并分析了 252 个针次。119 例患者（94%）最终诊断为恶性肿瘤。有可见核心的准确率为 92.5%，无可见核心的准确率为 70.0%（p<0.01），大样本量的准确率为 85.2%，小样本量的准确率为 70.2%（p<0.01）。单变量分析表明，可见核心的存在和大样本量与准确率相关。多变量分析表明，只有可见核心的存在具有统计学意义。
在 ROSE 不可用时，GVI 可预测正确的诊断。评估可见核心的存在比评估获得的样本量更敏感。
