Faias Sandra, Cravo Marília, Pereira da Silva João, Chaves Paula, Dias Pereira A
Gastroenterology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Rua Prof Lima Basto, 1099-023, Lisbon, Portugal.
Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
BMC Gastroenterol. 2020 Dec 9;20(1):413. doi: 10.1186/s12876-020-01565-9.
In current guidelines, endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is recommended in pancreatic cystic lesions (PCLs) with worrisome features (size ≥ 3 cm, mural nodule, or Wirsung dilation).
To evaluate the diagnostic ability and assess the accuracy of EUS-FNA in PCLs smaller than 3 cm.
Retrospective study of PCLs < 3 cm (2007-2016) undergoing EUS-FNA. Clinical, EUS and pancreatic cystic fluid (PCF) data were prospectively registered. Performance of EUS-FNA with PCF analysis for the detection of malignancy and accuracy in surgical cohort were analyzed.
We evaluated 115 patients with PCLs < 3 cm who underwent EUS-FNA. 19 patients underwent surgery, 7 had malignant, 8 pre-malignant, and the remaining 4 benign lesions. Mass/mural nodule was present in 27% of the cysts, CEA level was higher than 192 ng/mL in 39.4% of patients, and only 35% of cytologic samples were informative. Nevertheless, additional FNA for PCF analysis improved the diagnostic performance of EUS imaging-AUC = 0.80 versus AUC = 60.
EUS-FNA has good accuracy in PCLs < 3 cm. It confirmed malignancy even in lesions without worrisome features (nodule/mass), with two in every five resections showing high-risk/malignant lesions. EUS-FNA was also useful to diagnose benign cysts, possibly allowing surveillance to be stopped in one in every five patients.
在当前指南中，对于具有可疑特征（大小≥3 cm、壁结节或主胰管扩张）的胰腺囊性病变（PCL），推荐使用内镜超声引导下细针穿刺活检（EUS-FNA）。
评估EUS-FNA对小于3 cm的PCL的诊断能力并评估其准确性。
对2007年至2016年间接受EUS-FNA的小于3 cm的PCL进行回顾性研究。前瞻性记录临床、EUS和胰腺囊液（PCF）数据。分析EUS-FNA联合PCF分析检测恶性肿瘤的性能及在手术队列中的准确性。
我们评估了115例接受EUS-FNA的小于3 cm的PCL患者。19例患者接受了手术，其中7例为恶性病变，8例为癌前病变，其余4例为良性病变。27%的囊肿存在肿块/壁结节，39.4%的患者癌胚抗原水平高于192 ng/mL，只有35%的细胞学样本提供了有用信息。然而，额外的PCF分析细针穿刺活检提高了EUS成像的诊断性能——曲线下面积（AUC）=0.80，而之前为AUC = 0.60。
EUS-FNA对小于3 cm的PCL具有良好的准确性。即使在没有可疑特征（结节/肿块）的病变中也能确诊恶性肿瘤，每五例切除病例中有两例显示为高危/恶性病变。EUS-FNA对诊断良性囊肿也很有用，可能使五分之一的患者停止监测。
