超声内镜引导下经皮穿刺活检术与细针抽吸细胞学检查对胰腺囊肿的诊断准确性：系统评价和荟萃分析。

Diagnostic accuracy of EUS-guided through-the-needle-biopsies and simultaneously obtained fine needle aspiration for cytology from pancreatic cysts: A systematic review and meta-analysis.

机构信息

Department of Pathology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark.

出版信息

Pathol Res Pract. 2021 Apr;220:153368. doi: 10.1016/j.prp.2021.153368. Epub 2021 Feb 8.

DOI:10.1016/j.prp.2021.153368

PMID:33652239

Abstract

OBJECTIVES

To address the diagnostic accuracy of endoscopic ultrasound guided through-the-needle-biopsies (TTNBs) and simultaneously obtained cytology samples from pancreatic cysts compared to the final histopathological diagnosis of the surgical specimen, and to give an overview of ancillary tests performed on TTNBs.

METHODS

A literature search was conducted in MEDLINE, Embase and Scopus. Studies were included in the meta-analysis, if they had data for TTNB, cytology and a surgical specimen of pancreatic cysts as reference standard. The assessment of the risk of bias and quality of the included studies was conducted using the modified QUADAS-2 tool.

RESULTS

Ten studies with 99 patients were included in the meta-analysis. Data regarding study design and clinicopathological features were extracted systematically. For TTNB, pooled sensitivity was 0.86 (95 % CI 0.62-0.96), specificity 0.95 (95 % CI 0.79-0.99) and area under the curve (AUC) 0.86 for the diagnosis of a mucinous cyst and pooled sensitivity was 0.78 (95 % CI 0.61-0.89), specificity 0.99 (95 % CI 0.90-0.99) and AUC 0.92 for the diagnosis of a high-risk cyst. For a specific diagnosis, pooled sensitivity was 0.69 (95 % CI 0.50-0.83), specificity 0.47 (95 % CI 0.28-0.68) and AUC 0.49. For cytology performed simultaneously, pooled sensitivity was 0.46 (95 % CI 0.35-0.57), specificity 0.90 (95 % CI 0.46-0.99) and AUC 0.64 for the diagnosis of mucinous cysts, and pooled sensitivity was 0.38 (95 % CI 0.23-0.55), specificity 0.99 (95 % CI 0.90-0.99) and AUC 0.84 for the diagnosis of a high-risk cyst. For a specific diagnosis, pooled sensitivity was 0.29 (95 % CI 0.21-0.39), specificity 0.45 (95 % CI 0.25-0.66) and AUC 0.30. Furthermore, immunohistochemical stains can be useful to establish the specific cyst subtype.

CONCLUSIONS

TTNBs have a higher sensitivity and specificity than cytology for the diagnosis of mucinous cyst and high- risk cysts of the pancreas.

摘要

目的

探讨内镜超声引导下经皮穿刺活检术（TTNB）与同时获得的细胞学样本与胰腺囊肿的手术标本最终组织病理学诊断相比的诊断准确性，并概述 TTNB 上进行的辅助检查。

方法

在 MEDLINE、Embase 和 Scopus 中进行文献检索。如果研究有 TTNB、细胞学和胰腺囊肿的手术标本数据作为参考标准，则将其纳入荟萃分析。使用改良的 QUADAS-2 工具评估纳入研究的偏倚风险和质量。

结果

10 项研究共纳入 99 例患者进行荟萃分析。系统提取了有关研究设计和临床病理特征的数据。对于 TTNB，诊断黏液性囊肿的汇总敏感性为 0.86（95%CI 0.62-0.96），特异性为 0.95（95%CI 0.79-0.99），曲线下面积（AUC）为 0.86；诊断高危囊肿的汇总敏感性为 0.78（95%CI 0.61-0.89），特异性为 0.99（95%CI 0.90-0.99），AUC 为 0.92。对于特定诊断，汇总敏感性为 0.69（95%CI 0.50-0.83），特异性为 0.47（95%CI 0.28-0.68），AUC 为 0.49。同时进行细胞学检查，诊断黏液性囊肿的汇总敏感性为 0.46（95%CI 0.35-0.57），特异性为 0.90（95%CI 0.46-0.99），AUC 为 0.64；诊断高危囊肿的汇总敏感性为 0.38（95%CI 0.23-0.55），特异性为 0.99（95%CI 0.90-0.99），AUC 为 0.84。对于特定诊断，汇总敏感性为 0.29（95%CI 0.21-0.39），特异性为 0.45（95%CI 0.25-0.66），AUC 为 0.30。此外，免疫组织化学染色可用于确定特定的囊肿亚型。