Estrada Paul, Benson Mark, Gopal Deepak, Buehler Darya, Pfau Patrick
Section of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Diagn Cytopathol. 2019 Nov;47(11):1184-1189. doi: 10.1002/dc.24291. Epub 2019 Jul 29.
Cytology with rapid on-site evaluation (ROSE) has been shown to increase the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for solid pancreatic lesions. No data exists on the need for rapid onsite cytology in the evaluation of pancreatic cystic lesions (PCLs). The purpose of this study is to determine whether onsite cytology impacts the diagnostic yield of EUS-FNA of PCLs.
We prospectively examined all patients with PCLs who underwent EUS-FNA without onsite cytology over a 6-month period and compared this to a historical cohort of patients with PCLs who underwent EUS-FNA with ROSE in the previous 6 months. Comparison was made between the two groups based upon patient demographics, EUS cyst characteristics, and FNA fluid & cytopathology results.
A total of 100 EUS-FNA exams for PCLs were identified: 46 with ROSE and 54 without onsite cytology. The majority of cytology findings were negative or nondiagnostic, 87.0% in the ROSE group, 77.8% in the group without onsite cytology. There was no difference using EUS-FNA without onsite cytology compared to ROSE when measuring total diagnostic yield (22.2% vs 13.0%, P = .30), number of nondiagnostic specimens (50% vs 54%, P = .69), and number of needle passes (1.51 vs 1.57, P = .68).
(a) The majority of cytology results from EUS-FNA of cystic lesions are negative or nondiagnostic. (b) Having rapid onsite cytology evaluation of cystic lesions does not affect the number of needle passes nor diagnostic yield and is thus not recommended.
细胞学检查结合快速现场评估（ROSE）已被证明可提高内镜超声引导下细针穿刺活检（EUS-FNA）对实性胰腺病变的诊断准确性。目前尚无关于胰腺囊性病变（PCL）评估中快速现场细胞学检查必要性的数据。本研究的目的是确定现场细胞学检查是否会影响PCL的EUS-FNA诊断率。
我们前瞻性地检查了在6个月内接受EUS-FNA但未进行现场细胞学检查的所有PCL患者，并将其与前6个月接受EUS-FNA并进行ROSE的PCL患者历史队列进行比较。根据患者人口统计学、EUS囊肿特征以及FNA液体和细胞病理学结果对两组进行比较。
共识别出100例PCL的EUS-FNA检查：46例进行了ROSE，54例未进行现场细胞学检查。大多数细胞学检查结果为阴性或无法诊断，ROSE组为87.0%，未进行现场细胞学检查组为77.8%。在测量总诊断率（22.2%对13.0%，P = 0.30）、无法诊断标本数量（50%对54%，P = 0.69）和穿刺针数（1.51对1.57，P = 0.68）时，未进行现场细胞学检查的EUS-FNA与ROSE相比无差异。
（a）囊性病变的EUS-FNA细胞学检查结果大多为阴性或无法诊断。（b）对囊性病变进行快速现场细胞学评估不会影响穿刺针数或诊断率，因此不建议进行。
