Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Anatomic Pathology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
Scand J Gastroenterol. 2021 Apr;56(4):498-504. doi: 10.1080/00365521.2021.1880628. Epub 2021 Feb 4.
Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is influenced by several factors, primarily operator expertise. Formal training in EUS-FNA, as suggested by the European Society of Gastrointestinal Endoscopy and the American Society for Gastrointestinal Endoscopy guidelines, is not always available and is often expensive and time-consuming. In this study we evaluate factors influencing the diagnostic accuracy of pancreatic EUS-FNA.
In a retrospective study, 557 consecutive EUS-FNAs were evaluated. Several variables relating to the procedures were considered to calculate the EUS-FNA performance over eight years.
A total of 308 out of 557 EUS-FNAs were selected. Overall sensitivity of EUS-FNA was 66% (95% CI: 60.8-71.8), specificity 100%, and diagnostic accuracy 69% (95% CI: 64.0-74.4). An increase in diagnostic accuracy was observed to >90% using a new fine-needle biopsy (FNB) needle and in the case of simultaneous sampling of primary and metastatic lesions. Diagnostic accuracy >80% was observed after 250 procedures, in the absence of rapid on-site cytopathological examination (ROSE). Multivariate logistic regression analysis confirmed that the FNB needle, operator skill, and double EUS-FNA sampling are associated with high diagnostic accuracy.
The learning curve for EUS-FNA may be longer and a considerable number of procedures are needed to achieve high diagnostic accuracy in the absence of ROSE. However, the use of FNB needles and the simultaneous sampling of primary and metastatic lesions can rapidly improve the diagnostic accuracy of the procedure.
内镜超声引导下细针抽吸（EUS-FNA）的诊断准确性受多种因素影响，主要是操作人员的专业水平。欧洲胃肠道内镜学会和美国胃肠道内镜学会指南建议进行 EUS-FNA 的正式培训，但这种培训并非总是可用，而且往往昂贵且耗时。在这项研究中，我们评估了影响胰腺 EUS-FNA 诊断准确性的因素。
在一项回顾性研究中，评估了 557 例连续 EUS-FNA。考虑了与操作相关的多个变量，以在八年期间计算 EUS-FNA 的性能。
共选择了 557 例 EUS-FNA 中的 308 例。EUS-FNA 的总体敏感性为 66%（95%CI：60.8-71.8），特异性为 100%，诊断准确性为 69%（95%CI：64.0-74.4）。使用新的细针活检（FNB）针和同时采集原发性和转移性病变时，观察到诊断准确性增加到>90%。在没有快速现场细胞学检查（ROSE）的情况下，进行 250 次操作后观察到诊断准确性>80%。多变量逻辑回归分析证实，FNB 针、操作人员技能和双 EUS-FNA 采样与高诊断准确性相关。
在没有 ROSE 的情况下，EUS-FNA 的学习曲线可能更长，需要进行大量操作才能达到高诊断准确性。然而，使用 FNB 针和同时采集原发性和转移性病变可以迅速提高该操作的诊断准确性。
