Costa-Moreira Pedro, Vilas-Boas Filipe, Martins Diana, Moutinho-Ribeiro Pedro, Lopes Susana, Lopes Joanne, Barroca Helena, Macedo Guilherme
Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal.
Faculty of Medicine, University of Porto, Portugal.
Endosc Int Open. 2021 Mar;9(3):E401-E408. doi: 10.1055/a-1336-3170. Epub 2021 Feb 19.
The utility of suction during endoscopic ultrasound (EUS) fine-needle biopsy (FNB) using Franseen-tip needle remains unclear and has not been evaluated in randomized trials. We designed a randomized crossover trial to compare the diagnostic yield during EUS-FNB using a 22G Franseen-tip needle, with and without standard suction. Consecutive patients undergoing EUS-guided sampling of solid pancreatic lesions were recruited. A minimum of two passes were performed for each case: one with 20-mL syringe suction (S+) and another without (S-). The order of passes was randomized and the pathologist blinded. The endpoints were the diagnostic yield and the impact of blood contamination in the diagnosis. Fifty consecutive patients were enrolled. The overall diagnostic accuracy was 84 %. A diagnosis of malignancy was obtained in 70 samples: 36 in the S+group and 34 in the S-group. A statistically significant difference was seen in the diagnostic accuracy (S+: 78 % vs. S-: 72 %, < 0.01) and blood contamination (S+: 68 %; S-: 44 %, < 0.01). The sensitivity, specificity, negative likelihood ratio and positive likelihood ratio for S+vs. S-samples were 76.6 % vs. 73.9 %, 100 % vs. 100 % and 0.23 vs. 0.26, NA vs NA, respectively. A negative impact of blood contamination in the overall diagnostic yield wasn't seen, even in samples where suction was used (OR 0.36, = 0.15) We found a higher diagnostic yield with the use of suction. It was associated with a higher degree of sample blood contamination that did not affect the diagnostic performance.
在内镜超声（EUS）细针穿刺活检（FNB）过程中，使用 Franseen 头针时抽吸的作用仍不明确，且尚未在随机试验中进行评估。我们设计了一项随机交叉试验，以比较使用 22G Franseen 头针在 EUS-FNB 过程中，有标准抽吸和无标准抽吸时的诊断率。连续纳入接受 EUS 引导下实性胰腺病变采样的患者。每个病例至少进行两次穿刺：一次使用 20 mL 注射器抽吸（S+），另一次不抽吸（S-）。穿刺顺序随机安排，病理科医生不知情。终点指标为诊断率以及血液污染对诊断的影响。连续纳入 50 例患者。总体诊断准确率为 84%。在 70 个样本中确诊为恶性肿瘤：S+组 36 个，S-组 34 个。在诊断准确率（S+：78% 对 S-：72%，P<0.01）和血液污染情况（S+：68%；S-：44%，P<0.01）方面存在统计学显著差异。S+样本与 S-样本的敏感性、特异性、阴性似然比和阳性似然比分别为 76.6% 对 73.9%、100% 对 100%、0.23 对 0.26、无数据对无数据。即使在使用抽吸的样本中，也未发现血液污染对总体诊断率有负面影响（比值比 0.36，P = 0.15）。我们发现使用抽吸时诊断率更高。这与更高程度的样本血液污染相关，但并未影响诊断性能。
