Pausawasdi Nonthalee, Maipang Kotchakon, Sriprayoon Tassanee, Charatcharoenwitthaya Phunchai
Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Clin Endosc. 2022 Mar;55(2):279-286. doi: 10.5946/ce.2021.218-IDEN. Epub 2022 Jan 3.
BACKGROUND/AIMS: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a standard procedure for obtaining tissue from lesions near the gastrointestinal lumen. However, there is a scarcity of information on the diagnostic performance of EUS-FNA for abdominal lymphadenopathy of unknown causes. To assess the accuracy of EUS-FNA in diagnosing abdominal lymphadenopathy of unknown etiology.
The EUS records of patients with undiagnosed abdominal lymphadenopathy between 2010 and 2015 were reviewed.
A total of 42 patients were included in this study. Adequate specimens were obtained from 40 patients (95%). The final diagnoses were metastatic cancer (n=16), lymphoma (n=9), tuberculosis (n=8), inflammatory changes (n=6), and amyloidosis (n=1). For diagnosing malignancy, EUS-FNA had a sensitivity of 84.6%, specificity of 95.7%, positive predictive value of 91.7%, negative predictive value of 91.7%, and area under the receiver operating characteristic curve (AUROC) of 0.901. For the diagnosis of lymphoma, EUS-FNA was 100% accurate when combined with cytologic evaluation and immunohistochemical staining. The diagnostic sensitivity decreased to 75%, whereas the specificity remained 100%, for tuberculosis. The overall AUROC was 0.850. No procedure-related complications occurred.
EUS-FNA showed high diagnostic performance for abdominal lymphadenopathy of unknown causes, especially malignancy, lymphoma, and tuberculosis. Therefore, it is a crucial diagnostic tool for this patient population.
背景/目的：超声内镜引导下细针穿刺抽吸术（EUS-FNA）是从胃肠道腔附近病变获取组织的标准操作。然而，关于EUS-FNA对不明原因腹部淋巴结病的诊断性能的信息匮乏。旨在评估EUS-FNA在诊断不明病因腹部淋巴结病中的准确性。
回顾了2010年至2015年间未确诊腹部淋巴结病患者的EUS记录。
本研究共纳入42例患者。40例患者（95%）获得了足够的标本。最终诊断为转移性癌（n = 16）、淋巴瘤（n = 9）、结核病（n = 8）、炎症改变（n = 6）和淀粉样变性（n = 1）。对于诊断恶性肿瘤，EUS-FNA的敏感性为84.6%，特异性为95.7%，阳性预测值为91.7%，阴性预测值为91.7%，受试者操作特征曲线下面积（AUROC）为0.901。对于淋巴瘤的诊断，EUS-FNA联合细胞学评估和免疫组化染色时准确率为100%。对于结核病，诊断敏感性降至75%，而特异性仍为100%。总体AUROC为0.850。未发生与操作相关的并发症。
EUS-FNA对不明原因的腹部淋巴结病，尤其是恶性肿瘤、淋巴瘤和结核病，显示出较高的诊断性能。因此，它是该患者群体的关键诊断工具。
