Department of Gastroenterology, Hepatopancreatology and Digestive oncology, Erasme Hospital, Université Libre de Bruxelles, Belgium.
Department of Gastroenterology and Hepatology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Belgium.
Acta Gastroenterol Belg. 2021 Jul-Sep;84(3):451-455. doi: 10.51821/84.3.010.
Endoscopic ultrasound fine-needle aspiration/biopsy (EUS-FNA/FNB) is highly accurate, but discrepancies between cytological and surgical diagnoses are still observed. We aimed to determine its accuracy and monitor quality indicators in our facilities.
We performed a retrospective review of all cases of pancreatic solid lesions evaluated by EUS-FNA/FNB, between July 2015 and June 2018, in two centers. Cytological and surgical findings were categorized into five groups: benign, malignant, suspect of malignancy, undetermined and insufficient for diagnosis. Final diagnosis was based on surgical diagnosis and, in patients who did not undergo surgery, on clinical outcome after 6 months follow-up.
Altogether, 142 patients were included. FNA was the preferred tissue acquisition method (88%), with a predilection for the FNA 22G needle (57%). Cytology was insufficient for diagnosis in 2 cases, therefore a full diagnostic sample was available in 98.6% of the patients (>90%, ESGE target). Fifty-five (38.7%) patients underwent surgery. In term of cancer diagnosis, comparison with final surgical pathology (n=55) revealed 89% true positives, 5.5% true negatives, 3.6% false positives and 1.8% false negatives. When combining surgical diagnosis and clinical outcomes together, EUS-guided sampling sensitivity was 97.4% (92.5-99.5), specificity was 92.3% (74.9-99.1), positive predictive value was 98.2% (93.6- 99.5), negative predictive value was 88.9% (72.3-96.1) and accuracy was 96.4% (91.9-98.8). Post-procedural acute pancreatitis was reported in 2 patients (1.4%).
These results reveal a performance for diagnostic tissue sampling well above the ESGE proposed target standard. Also, the uncommon high specificity illustrates the determining role of the pathologist's final interpretation and diagnosis.
内镜超声引导下细针抽吸/活检（EUS-FNA/FNB）的准确率很高，但细胞学和手术诊断之间仍存在差异。本研究旨在确定其在我们机构的准确性，并监测质量指标。
我们对 2015 年 7 月至 2018 年 6 月期间在两个中心接受 EUS-FNA/FNB 评估的胰腺实性病变的所有病例进行了回顾性分析。细胞学和手术结果分为五类：良性、恶性、疑似恶性、不确定和诊断不足。最终诊断基于手术诊断，对于未行手术的患者，基于 6 个月随访的临床结果。
共纳入 142 例患者。FNA 是首选的组织采集方法（88%），22G 针（57%）优先使用。2 例细胞学诊断不足，因此 98.6%（>90%，ESGE 目标）的患者获得了完整的诊断样本。55 例（38.7%）患者接受了手术。在癌症诊断方面，与最终的手术病理（n=55）比较，真阳性率为 89%，真阴性率为 5.5%，假阳性率为 3.6%，假阴性率为 1.8%。当将手术诊断和临床结果结合起来时，EUS 引导下取样的敏感性为 97.4%（92.5-99.5），特异性为 92.3%（74.9-99.1），阳性预测值为 98.2%（93.6-99.5），阴性预测值为 88.9%（72.3-96.1），准确率为 96.4%（91.9-98.8）。术后发生急性胰腺炎 2 例（1.4%）。
这些结果表明，诊断性组织取样的性能明显高于 ESGE 提出的目标标准。此外，罕见的高特异性说明了病理学家最终解释和诊断的决定性作用。
