经内镜超声引导下对腹膜病变进行细针穿刺活检（EUS-FNB）：一项前瞻性队列先导研究。
Endoscopic ultrasound guided fine needle biopsy (EUS-FNB) from peritoneal lesions: a prospective cohort pilot study.
作者信息
Kongkam Pradermchai, Orprayoon Theerapat, Yooprasert Sirilak, Sirisub Nakarin, Klaikaew Naruemon, Sanpawat Anapat, Safa Shahram, Ridtitid Wiriyaporn, Kullavanijaya Pinit, Rerknimitr Rungsun
机构信息
Excellence Center for Gastrointestinal Endoscopy, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
出版信息
BMC Gastroenterol. 2021 Oct 24;21(1):400. doi: 10.1186/s12876-021-01953-9.
BACKGROUND
Diagnostic laparoscopy is often a necessary, albeit invasive, procedure to help resolve undiagnosed peritoneal diseases. Previous retrospective studies reported that EUS-FNA is feasible on peritoneal and omental lesions, however, EUS-FNA provided a limited amount of tissue for immunohistochemistry stain (IHC).
AIM
This pilot study aims to prospectively determine the effectiveness of EUS-FNB regarding adequacy of tissue for IHC staining, diagnostic rate and the avoidance rate of diagnostic laparoscopy or percutaneous biopsy in patients with these lesions.
METHODS
From March 2017 to June 2018, patients with peritoneal or omental lesions identified by CT or MRI at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand were prospectively enrolled in the study. All Patients underwent EUS-FNB. For those with negative pathological results of EUS-FNB, percutaneous biopsy or diagnostic laparoscopy was planned. Analysis uses percentages only due to small sample sizes.
RESULTS
A total of 30 EUS-FNB passes were completed, with a median of 3 passes (range 2-3 passes) per case. For EUS-FNB, the sensitivity, specificity, PPV, NPV and accuracy of EUS-FNB from peritoneal lesions were 63.6%, 100%, 100%, 20% and 66.7% respectively. Adequate tissue for IHC stain was found in 25/30 passes (80%). The tissues from EUS results were found malignant in 7/12 patients (58.3%). IHC could be done in 10/12 patients (83.3%). Among the five patients with negative EUS results, two underwent either liver biopsy of mass or abdominal paracentesis, showing gallbladder cancer and adenocarcinoma. Two patients refused laparoscopy due to advanced pancreatic cancer and worsening ovarian cancer. The fifth patient had post-surgical inflammation only with spontaneous resolution. The avoidance rate of laparoscopic diagnosis was 58.3%. No major adverse event was observed.
CONCLUSIONS
EUS-FNB from peritoneal lesions provided sufficient core tissue for diagnosis and IHC. Diagnostic laparoscopy can often be avoided in patients with peritoneal lesions.
背景
诊断性腹腔镜检查通常是一种必要的、尽管具有侵入性的程序，有助于解决未确诊的腹膜疾病。既往回顾性研究报告称，超声内镜引导下细针穿刺抽吸术（EUS-FNA）对腹膜和网膜病变可行，然而，EUS-FNA为免疫组织化学染色（IHC）提供的组织量有限。
目的
这项前瞻性研究旨在确定超声内镜引导下细针穿刺活检术（EUS-FNB）在为IHC染色提供足够组织、诊断率以及避免对这些病变患者进行诊断性腹腔镜检查或经皮活检方面的有效性。
方法
2017年3月至2018年6月，在泰国曼谷朱拉隆功国王纪念医院通过CT或MRI发现有腹膜或网膜病变的患者被前瞻性纳入本研究。所有患者均接受EUS-FNB。对于EUS-FNB病理结果为阴性的患者，计划进行经皮活检或诊断性腹腔镜检查。由于样本量小，分析仅使用百分比。
结果
共完成30次EUS-FNB穿刺，每例患者的穿刺次数中位数为3次（范围2 - 3次）。对于EUS-FNB，来自腹膜病变的EUS-FNB的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为63.6%、100%、100%、20%和66.7%。在30次穿刺中有25次（80%）获得了足够用于IHC染色的组织。EUS检查结果显示12例患者中有7例（58.3%）组织为恶性。12例患者中有10例（83.3%）可进行IHC检查。在5例EUS结果为阴性的患者中，2例接受了肝脏肿块活检或腹腔穿刺，结果显示为胆囊癌和腺癌。2例患者因晚期胰腺癌和卵巢癌病情恶化而拒绝腹腔镜检查。第5例患者仅为术后炎症，自行缓解。腹腔镜诊断的避免率为58.3%。未观察到重大不良事件。
结论
来自腹膜病变的EUS-FNB提供了足够的核心组织用于诊断和IHC。腹膜病变患者通常可以避免进行诊断性腹腔镜检查。
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