Jeon Tae Yeon, Moon Sung-Hoon, Kim Jong Hyeok, Lim Hyun, Kang Ho Suk, Park Ji-Won, Kim Sung-Eun, Min Soo Kee
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea.
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea.
J Clin Med. 2021 Aug 27;10(17):3850. doi: 10.3390/jcm10173850.
Endoscopic ultrasound (EUS)-guided sampling has been widely used for pathologic diagnosis of pancreatic lesions and intra-abdominal lymphadenopathy. However, its effectiveness for diagnostic decision making in indeterminate radiological diagnosis has not been well determined.
From March 2012 to October 2015, 98 consecutive patients who underwent EUS-guided FNA for solid intra-abdominal lesions were retrospectively analyzed (100 procedures). The purpose of EUS-guided sampling was classified as (1) confirmation of a high-confidence radiological diagnosis (High-confidence group) or (2) decision making in the differential diagnostic dilemma for indeterminate radiological diagnosis (Indeterminate group). The accuracies of EUS-guided sampling according to the purpose were analyzed and then compared.
Of the 100 procedures, 22 procedures (22%) came under the Indeterminate group, whereas 78 came under the High-confidence group. The accuracies did not differ between the Indeterminate and the High-confidence groups (86.4% vs. 88.5%, = 1.000). Clinical conditions that required EUS-guided sampling for indeterminate radiological diagnosis were (1) pancreatic cancer vs. benign disease ( = 8; e.g., pancreatic cancer vs. mass-forming pancreatitis), (2) recurrence of previous/pre-existing cancer vs. benign disease ( = 5; e.g., recurrent gastric cancer vs. reactive lymph node), (3) pathologic differentiation of presumed malignancy ( = 6; e.g., lymphadenopathies in the previous history of esophageal cancer and colon cancer), or (4) miscellaneous ( = 3; e.g., tuberculous lymphadenopathy vs. other condition).
EUS-guided sampling demonstrated an accuracy of 86.4% in the clinical setting of indeterminate radiological diagnosis, which was not different from that of the confirmation of high-confidence diagnosis.
超声内镜（EUS）引导下采样已广泛用于胰腺病变和腹腔内淋巴结病的病理诊断。然而，其在不确定的放射学诊断中用于决策的有效性尚未得到很好的确定。
回顾性分析2012年3月至2015年10月期间连续98例行EUS引导下细针穿刺活检（FNA）的腹腔实性病变患者（共100例操作）。EUS引导下采样的目的分为：（1）确诊高度可疑的放射学诊断（高度可疑组）；（2）在不确定的放射学诊断的鉴别诊断困境中进行决策（不确定组）。分析并比较根据目的分类的EUS引导下采样的准确性。
在100例操作中，22例（22%）属于不确定组，78例属于高度可疑组。不确定组和高度可疑组的准确性无差异（86.4%对88.5%，P = 1.000）。需要EUS引导下采样以进行不确定的放射学诊断的临床情况包括：（1）胰腺癌与良性疾病（n = 8；例如，胰腺癌与肿块型胰腺炎）；（2）既往/原有癌症复发与良性疾病（n = 5；例如，复发性胃癌与反应性淋巴结）；（3）推测为恶性肿瘤的病理分化（n = 6；例如，食管癌和结肠癌既往史中的淋巴结病）；或（4）其他（n = 3；例如，结核性淋巴结病与其他情况）。
在不确定的放射学诊断的临床环境中，EUS引导下采样的准确率为86.4%，与高度可疑诊断的确诊率无差异。
