Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
J Surg Oncol. 2021 Sep;124(3):343-353. doi: 10.1002/jso.26526. Epub 2021 Jun 13.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the preferred method for diagnosing pancreatic masses. While the diagnostic success of EUS-FNA is widely accepted, the actual performance of EUS-FNA is not known. This study sought to define the EUS-FNA accuracy compared with the gold standard, surgically resected specimens. The study was a single institution, retrospective, and chart review of patients with surgically resected pancreatic specimens from 2005 to 2015 with a preoperative EUS-FNA or biliary brushing. Cytological reports were organized from least concerning (i.e., low chance of malignancy) to most concerning (high chance of malignancy) into eight cytologic categories. We identified 741 cytologic cases: 530 EUS-FNA and 211 endoscopic brushings. For EUS-FNA samples, 62.5% of "benign" samples proved to be "benign" on surgical pathology. A cytologic diagnosis of "suspicious for malignancy" or "positive for malignancy" were concordant with a cancer diagnosis on surgical pathology 93.3% and 98.0% of cases, respectively. EUS-FNA proved to be highly reliable at diagnosing malignancy for cytologic samples that were "suspicious" or "positive" for malignancy. Paired with supportive clinical data, these interpretations may be used to justify cancer treatment.
内镜超声引导下细针抽吸（EUS-FNA）是诊断胰腺肿块的首选方法。虽然 EUS-FNA 的诊断成功率得到广泛认可，但 EUS-FNA 的实际表现尚不清楚。本研究旨在确定 EUS-FNA 与金标准（手术切除标本）相比的准确性。该研究为单中心回顾性研究，对 2005 年至 2015 年间接受手术切除胰腺标本的患者进行了回顾，这些患者术前接受了 EUS-FNA 或胆道刷检。细胞学报告根据从最不相关（即恶性机会低）到最相关（恶性机会高）的顺序组织成八个细胞学类别。我们共确定了 741 例细胞学病例：530 例 EUS-FNA 和 211 例内镜刷检。对于 EUS-FNA 样本，62.5%的“良性”样本在手术病理中被证实为“良性”。细胞学诊断为“可疑恶性”或“阳性恶性”与手术病理上的癌症诊断分别有 93.3%和 98.0%的一致性。对于细胞学上可疑或阳性的恶性样本，EUS-FNA 在诊断恶性肿瘤方面具有高度可靠性。结合支持性临床数据，这些解释可用于证明癌症治疗的合理性。
