Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan.
Division of Endoscopy, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, 060-8648, Japan.
Dig Dis Sci. 2019 Jul;64(7):2006-2013. doi: 10.1007/s10620-018-5435-3. Epub 2019 Jan 2.
Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has high diagnostic accuracy for pancreatic diseases. However, the effect of mass size on diagnostic accuracy has yet to be determined, especially for small pancreatic lesions. We aimed to determine the effect of pancreatic mass size on the diagnostic yield of EUS-FNA.
We searched the database in Hokkaido University Hospital between May 2008 and December 2016 and identified solid pancreatic lesions examined by EUS-FNA. All lesions were stratified into five groups based on mass sizes: groups A (< 10 mm), B (10-20 mm), C (20-30 mm), D (30-40 mm) and E (≥ 40 mm). The sensitivity, specificity, diagnostic accuracy and adverse event rate were retrospectively evaluated.
We analyzed a total of 788 solid pancreatic lesions in 761 patients. The patients included 440 males (57.8%) with a mean age of 65.7 years. The sensitivities in groups A (n = 36), B (n = 223), C (n = 304), D (n = 147) and E (n = 78) were 89.3%, 95.0%, 97.4%, 98.5% and 98.7%, respectively, and they significantly increased as the mass size increased (P < 0.01, chi-squared test for trend). The diagnostic accuracies were 91.7%, 96.4%, 97.7%, 98.6% and 98.7%, respectively, and they also significantly increased as the mass size increased (P = 0.03). Multivariate analysis showed that pancreatic mass size was associated with diagnostic accuracy. The adverse event rates were not significantly different among the five groups.
The sensitivities and diagnostic accuracies of EUS-FNA for solid pancreatic lesions are higher for lesions ≥ 10 mm in size, and they are strongly correlated with mass size.
内镜超声引导下细针抽吸术（EUS-FNA）对胰腺疾病具有较高的诊断准确性。然而，肿块大小对诊断准确性的影响尚未确定，尤其是对于小的胰腺病变。本研究旨在确定胰腺肿块大小对 EUS-FNA 诊断效果的影响。
我们在 2008 年 5 月至 2016 年 12 月期间检索北海道大学医院的数据库，确定了经 EUS-FNA 检查的胰腺实性病变。根据肿块大小将所有病变分为五组：A 组（<10mm）、B 组（10-20mm）、C 组（20-30mm）、D 组（30-40mm）和 E 组（≥40mm）。回顾性评估了灵敏度、特异性、诊断准确性和不良事件发生率。
我们共分析了 761 例患者的 788 个胰腺实性病变。患者包括 440 名男性（57.8%），平均年龄为 65.7 岁。A 组（n=36）、B 组（n=223）、C 组（n=304）、D 组（n=147）和 E 组（n=78）的灵敏度分别为 89.3%、95.0%、97.4%、98.5%和 98.7%，随着肿块大小的增加而显著增加（P<0.01，趋势性卡方检验）。诊断准确率分别为 91.7%、96.4%、97.7%、98.6%和 98.7%，也随着肿块大小的增加而显著增加（P=0.03）。多变量分析显示，胰腺肿块大小与诊断准确性相关。五组间不良事件发生率无显著差异。
EUS-FNA 对直径≥10mm 的胰腺实性病变具有较高的灵敏度和诊断准确性，与肿块大小密切相关。
