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.
PLoS One. 2022 Mar 23;17(3):e0263982. doi: 10.1371/journal.pone.0263982. eCollection 2022.
BACKGROUND/AIM: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the primary method for tissue acquisition of intra-abdominal masses. However, the main limitation of cytology alone is the lack of tissue architecture and inadequate samples. This study aimed to evaluate the diagnostic performance of combined conventional cytology and cell block preparation obtained from EUS-FNA of intra-abdominal masses without Rapid On-site Evaluation (ROSE).
Cytologic smears and cell block slides of 166 patients undergoing EUS-FNA during 2010-2015 were reviewed by an experienced cytopathologist blinded to clinical data.
125 patients had neoplastic lesions. Pancreatic adenocarcinoma was the most common etiology (35.5%), followed by lymph node metastasis (27.7%). The mean mass size was 2.5±1.3 cm. The mean number of passes was 1.9±1.28. Tissue adequacy for conventional cytology and cell block preparation was 78.9% and 78.1%, respectively. Factors associated with tissue adequacy were assessed. For cytology, lesions of > 2.1 cm, masses in the pancreatic body or tail, malignancy, and pancreatic cancer were positively associated with adequate cellularity. For cell block preparation, lesions of > 3 cm and malignancy were associated with increased tissue adequacy. The conventional cytology alone had a sensitivity of 68.5%, a specificity of 95.7%, and an area under the receiver operating characteristics (AUROC) of 0.821. The cell block preparation alone had a sensitivity of 65.4%, a specificity of 96%, and an AUROC of 0.807. The combined conventional cytology and cell block preparation performed significantly better than either method alone (p<0.05), as demonstrated by an increased AUROC of 0.853. Furthermore, cell block detected malignancy in 9.3% of cases where the cytologic smears failed to identify malignant cells.
The combined conventional cytology and cell block preparation increased the diagnostic accuracy of EUS-FNA compared to either method alone. This approach should be implemented in routine practice, especially where ROSE is unavailable.
背景/目的：内镜超声引导下细针抽吸术（EUS-FNA）是获取腹腔内肿块组织的主要方法。然而，单凭细胞学检查的主要局限性是缺乏组织结构和样本不足。本研究旨在评估在没有即时现场评估（ROSE）的情况下，对腹腔内肿块进行 EUS-FNA 获得的常规细胞学和细胞块制备的联合诊断性能。
回顾性分析 2010 年至 2015 年间 166 例行 EUS-FNA 的患者的细胞学涂片和细胞块切片，由一位经验丰富的细胞病理学家进行评估，该病理学家对临床数据不知情。
125 例患者为肿瘤性病变。最常见的病因是胰腺腺癌（35.5%），其次是淋巴结转移（27.7%）。平均肿块大小为 2.5±1.3cm。平均穿刺次数为 1.9±1.28 次。常规细胞学和细胞块制备的组织充分性分别为 78.9%和 78.1%。评估了与组织充分性相关的因素。对于细胞学检查，病变直径>2.1cm、肿块位于胰体或胰尾、恶性肿瘤和胰腺癌与细胞丰富度呈正相关。对于细胞块制备，病变直径>3cm 和恶性肿瘤与增加的组织充分性相关。常规细胞学检查的敏感性为 68.5%，特异性为 95.7%，受试者工作特征曲线下面积（AUROC）为 0.821。单独的细胞块制备的敏感性为 65.4%，特异性为 96%，AUROC 为 0.807。与单独使用任何一种方法相比，常规细胞学和细胞块制备的联合应用显著提高了诊断准确性（p<0.05），表现为 AUROC 增加至 0.853。此外，细胞块制备在细胞学涂片未能识别恶性细胞的情况下，发现了 9.3%的恶性肿瘤病例。
与单独使用任何一种方法相比，常规细胞学和细胞块制备的联合应用提高了 EUS-FNA 的诊断准确性。这种方法应该在常规实践中实施，特别是在没有 ROSE 的情况下。
