两种专门的组织学针在超声内镜（EUS）引导下肝活检中的比较：一项初步研究。
Comparison of Two Specialized Histology Needles for Endoscopic Ultrasound (EUS)-Guided Liver Biopsy: A Pilot Study.
机构信息
Division of Gastroenterology and Hepatology, H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, CA, 92868, USA.
Pathology Department, University of California, Irvine Medical Center, Orange, CA, 92868, USA.
出版信息
Dig Dis Sci. 2021 May;66(5):1700-1706. doi: 10.1007/s10620-020-06391-3. Epub 2020 Jun 17.
BACKGROUND
EUS-guided liver biopsy (EUS-LB) has been shown to be a safe and effective alternative to percutaneous liver biopsy. The optimal needle device and technique for EUS-LB is still evolving. The aim of this study was to compare the efficacy of two second-generation 19G fine-needle biopsy (FNB) (Franseen- and Fork-tip) devices for EUS-LB.
METHODS
This is a repeated-measure crossover study with a prospectively maintained cohort of patients. We performed EUS-LB with a one-pass and single-actuation method using two 19G FNB needles in 22 consecutive patients between 10/2018 and 9/2019. Patients were randomized to left vs right liver lobes to be biopsied as well as the needle sequence. The specimens obtained were evaluated for adequacy for histologic diagnosis. The primary outcome was number of complete portal tracts (CPTs), post-fix aggregate, and longest specimen length. Secondary outcomes were prefix aggregate specimen length and the specimen adequacy judged by two expert pathologists.
RESULTS
A total of 44 liver biopsies were performed in 22 patients. The CPTs were higher in the Franseen-tip needle group compared to the Fork-tip needle group (14.4 vs 9.5, p = 0.043). Post-fix aggregate specimen length (44.9 mm vs 34.6 mm, p = 0.097), the post-fix longest specimen length (19.9 mm vs 13.7 mm, p = 0.175), and prefix aggregate specimen length (51.7 mm vs 45 mm, p = 0.265) were not significantly different. Both needles showed similarly high histologic adequacy (100% vs 95.5%, p = 0.312). Interestingly, the right of the liver showed higher yield of CPTs with both needles (Franseen, 16.2 vs. 12.8, p = 0.003, the Fork-tip, 12.8 vs. 7.0, p < 0.0001).
CONCLUSION
EUS-guided liver biopsy using the 19G Franseen-tip needle may provide more CPTs than 19G Fork-tip needle on a single-pass, single-actuation comparison.
背景
超声内镜引导下肝活检（EUS-LB）已被证明是一种安全有效的经皮肝活检替代方法。EUS-LB 的最佳针具和技术仍在不断发展。本研究旨在比较两种第二代 19G 细针活检（FNB）（Franseen 和 Fork-tip）装置在 EUS-LB 中的疗效。
方法
这是一项前瞻性维护队列的重复测量交叉研究。我们在 2018 年 10 月至 2019 年 9 月期间，对 22 例连续患者使用一种单次通过、单次操作的方法进行 EUS-LB，使用两种 19G FNB 针。患者随机分为左叶或右叶进行活检以及针序。评估获得的标本进行组织学诊断的充分性。主要结果是完整的门脉小体（CPT）数量、固定后总体积和最长标本长度。次要结果是固定前总体积标本长度和两位专家病理学家判断的标本充分性。
结果
共对 22 例患者的 44 次肝活检进行了分析。与 Fork-tip 针组相比，Franseen-tip 针组的 CPT 更高（14.4 比 9.5，p=0.043）。固定后总体积标本长度（44.9 毫米比 34.6 毫米，p=0.097）、固定后最长标本长度（19.9 毫米比 13.7 毫米，p=0.175）和固定前总体积标本长度（51.7 毫米比 45 毫米，p=0.265）无显著差异。两种针均显示出相似的高组织学充分性（100%比 95.5%，p=0.312）。有趣的是，两种针均显示右叶的 CPT 产量更高（Franseen，16.2 比 12.8，p=0.003，Fork-tip，12.8 比 7.0，p<0.0001）。
结论
与 19G Fork-tip 针相比，EUS 引导下肝活检使用 19G Franseen-tip 针在单次通过、单次操作的比较中可能提供更多的 CPT。
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