Fitzpatrick Megan J, Hernandez-Barco Yasmin Genevieve, Krishnan Kumar, Brugge William, Casey Brenna, Pitman Martha B
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
J Am Soc Cytopathol. 2019 Jul-Aug;8(4):212-219. doi: 10.1016/j.jasc.2019.03.001. Epub 2019 Mar 11.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the standard diagnostic procedure for many intrathoracic and intra-abdominal lesions. Next-generation fine-needle biopsies (FNBs) can increase diagnostic yield by procuring tissue suitable for histological processing. We evaluate the diagnostic yield and operating characteristics of the SharkCore (SC; Medtronic Corp., Minneapolis, MN) FNB in a tertiary referral facility.
We performed a single-center retrospective review of SC-FNB-acquired tissue between January 2014 and March 2018. Patient demographic data, endoscopic features, and pathology data were obtained from the electronic medical record. Diagnostic yield was assessed by the ability to obtain a definitive diagnosis, defined as malignant or benign interpretations. Operating characteristics were also calculated.
A total of 179 lesions were sampled with the SC-FNB in 157 patients (mean age: 63 years, 57% male). Of these, 31 lesions were concomitantly sampled with a conventional FNA needle. Most lesions were pancreatic (49%). Diagnostic yield was 86%, which was independent of lesion location, lesion size and needle gauge. Diagnostic accuracy was highest when both histology and cytology specimens were analyzed concurrently (96.5%). In patients with a history of chronic pancreatitis, accuracy, sensitivity, and negative predictive value were reduced (71.4%, 20.0%, and 69.2%, respectively). Rapid onsite evaluation (ROSE) occurred in 64.8% of cases and was more likely to be diagnostic at the time of rapid evaluation if SC-acquired tissue was utilized versus FNA-acquired tissue (P = 0.03); however, final diagnostic yield did not differ between needles (P = 0.13).
SC-FNB shows high diagnostic yield and accuracy and provides diagnostic tissue for ROSE. SC-FNB is an effective alternative to conventional FNA.
内镜超声引导下细针穿刺抽吸术（EUS-FNA）是许多胸内和腹内病变的标准诊断程序。新一代细针活检（FNB）可通过获取适合组织学处理的组织来提高诊断率。我们在一家三级转诊机构评估了SharkCore（SC；美敦力公司，明尼阿波利斯，明尼苏达州）FNB的诊断率和操作特性。
我们对2014年1月至2018年3月期间通过SC-FNB获取的组织进行了单中心回顾性研究。从电子病历中获取患者人口统计学数据、内镜特征和病理数据。通过获得明确诊断的能力来评估诊断率，明确诊断定义为恶性或良性解读。还计算了操作特性。
157例患者（平均年龄：63岁，57%为男性）的179个病变接受了SC-FNB采样。其中，31个病变同时用传统FNA针采样。大多数病变位于胰腺（49%）。诊断率为86%，与病变位置、病变大小和针径无关。同时分析组织学和细胞学标本时诊断准确性最高（96.5%）。有慢性胰腺炎病史的患者，准确性、敏感性和阴性预测值降低（分别为71.4%、20.0%和69.2%）。64.8%的病例进行了快速现场评估（ROSE），与FNA获取的组织相比，使用SC获取的组织在快速评估时更有可能诊断（P = 0.03）；然而，两种针的最终诊断率没有差异（P = 0.13）。
SC-FNB显示出高诊断率和准确性，并为ROSE提供诊断组织。SC-FNB是传统FNA的有效替代方法。
