Oh Dongwook, Seo Dong-Wan, Hong Seung-Mo, Song Tae Jun, Park Do Hyun, Lee Sang Soo, Lee Sung Koo, Kim Myung-Hwan
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Endosc Ultrasound. 2019 Sep-Oct;8(5):342-347. doi: 10.4103/eus.eus_34_19.
EUS-guided tissue acquisition with rapid on-site cytologic evaluation (ROSE) has been used to increase the diagnostic yield. However, ROSE is not available in many centers. To date, only a few studies have assessed the adequacy of histologic cores in macroscopic on-site evaluation (MOSE) during EUS-guided fine-needle biopsy (EUS-FNB). Blood contamination of histologic core specimens lowers the sample quality and the diagnostic yield. Therefore, we evaluated the efficacy of MOSE using filter paper to increase the adequacy of histologic core specimens while minimizing blood contamination.
Seventy-nine consecutive patients with an intraabdominal mass underwent EUS-FNB between March 2017 and October 2018. Histologic specimens obtained using EUS-FNB were expelled onto filter paper, and the histologic procurement rate on MOSE was evaluated.
EUS-FNB using a 20-gauge Procore needle or a 22-gauge Acquire needle was successful in all patients. The mean number of needle passes was 2.8 ss0.8. Visible histologic cores were observed in 94.9% (75/79) of the patients. Blood-contaminated specimens with scanty histologic cores were obtained in 5.1% (4/79) of the patients. On microscopic examination, 92.4% (73/79) of the histologic samples were graded as optimal. The diagnostic accuracy, sensitivity, and specificity were 94.5%, 94.3%, and 100%, respectively. Mild postprocedural adverse events occurred in 2 patients (2.5%: n = 1, transient fever; n = 1, acute pancreatitis).
MOSE using filter paper provided adequate histologic samples while minimizing blood contamination. MOSE can also increase the diagnostic accuracy when ROSE is not available.
内镜超声引导下组织获取联合快速现场细胞学评估（ROSE）已被用于提高诊断率。然而，许多中心无法开展ROSE。迄今为止，仅有少数研究评估了内镜超声引导下细针穿刺活检（EUS-FNB）过程中宏观现场评估（MOSE）时组织芯的充足性。组织芯标本的血液污染会降低样本质量和诊断率。因此，我们评估了使用滤纸进行MOSE的效果，以提高组织芯标本的充足性，同时尽量减少血液污染。
2017年3月至2018年10月期间，79例腹腔内肿块患者连续接受了EUS-FNB。使用EUS-FNB获取的组织标本被挤到滤纸上，并评估MOSE时的组织获取率。
所有患者使用20G Procore针或22G Acquire针进行EUS-FNB均成功。平均穿刺针数为2.8±0.8次。94.9%（75/79）的患者观察到可见的组织芯。5.1%（4/79）的患者获得了血液污染且组织芯稀少的标本。显微镜检查显示，92.4%（73/79）的组织样本分级为最佳。诊断准确性、敏感性和特异性分别为94.5%、94.3%和100%。2例患者（2.5%：1例为短暂发热；1例为急性胰腺炎）出现轻度术后不良事件。
使用滤纸进行MOSE可提供充足的组织样本，同时尽量减少血液污染。当无法开展ROSE时，MOSE也可提高诊断准确性。
