Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
J Gastroenterol Hepatol. 2023 May;38(5):733-739. doi: 10.1111/jgh.16137. Epub 2023 Feb 11.
In the absence of rapid on-site evaluation (ROSE), it is not clear which method of tissue preparation is best to process tissue obtained from EUS guidance. Cytological smearing (CS), cell block (CB), and direct histology (DH) are the available techniques.
To compare the diagnostic yield of three techniques of tissue preparation for EUS-guided tissue acquisition without ROSE.
Patients who were referred for EUS-FNA of peri-gastrointestinal masses were recruited. Without ROSE, each lesion was biopsied with three needle passes, and the order in which tissue is prepared was randomized to either (i) CS + CB, (ii) CB only, or (iii) DH only. The prepared specimens were reviewed.
A total of 243 specimens were taken from 81 patients. Tissue diagnosis was achieved in 78/81 (96.3%) of patients, including 63 neoplasms (PDAC [n = 45], pancreatic neuroendocrine tumors [PNET; n = 4], cholangiocarcinoma [n = 5], metastatic disease [n = 4], lymphoma [n = 1], linitis plastica [n = 2], leiomyoma [n = 2]) and 15 benign pathologies (chronic pancreatitis [n = 8], reactive nodes [n = 5], inflammatory biliary stricture [n = 1], and pancreatic rest [n = 1]). The three non-diagnostic cases were found to be PDAC (n = 2) and PNET (n = 1). Sensitivity and diagnostic accuracy was highest with DH (94 and 95%), which was significantly better than that by CS + CB (43 and 54%; P = 0.0001) and CB-only preparations (32 and 48.6%; P < 0.0001). There was no significant difference between the CS + CB and CB-only arms (P > 0.22).
Without ROSE, our findings suggest that with just a single pass, DH should be the tissue preparation method of choice given its significantly higher diagnostic accuracy compared with CS and/or CB techniques.
比较三种无快速现场评估（ROSE）的内镜超声引导下组织获取的组织制备技术的诊断产量。
招募因胃肠道周围肿块的内镜超声引导细针抽吸（EUS-FNA）而被转介的患者。无 ROSE 的情况下，每个病变用 3 次穿刺活检，制备组织的顺序随机分为 3 组：（i）细胞学涂片（CS）+细胞块（CB），（ii）仅 CB，或（iii）仅 DH。对制备的标本进行回顾性分析。
总共从 81 例患者中采集了 243 个标本。78/81（96.3%）例患者的组织诊断得到了明确，包括 63 个肿瘤（PDAC[45 例]、胰腺神经内分泌肿瘤[PNET；4 例]、胆管癌[5 例]、转移性疾病[4 例]、淋巴瘤[1 例]、弥漫型胃癌[2 例]、平滑肌瘤[2 例]）和 15 个良性病理（慢性胰腺炎[8 例]、反应性淋巴结[5 例]、炎性胆道狭窄[1 例]和胰腺残存量[1 例]）。3 例非诊断病例为 PDAC（2 例）和 PNET（1 例）。DH 的敏感性和诊断准确性最高（94%和 95%），明显优于 CS+CB（43%和 54%；P=0.0001）和仅 CB 制备（32%和 48.6%；P<0.0001）。CS+CB 与仅 CB 组之间无显著差异（P>0.22）。
在无 ROSE 的情况下，我们的研究结果表明，与 CS 和/或 CB 技术相比，DH 具有更高的诊断准确性，因此仅进行一次穿刺时，DH 应该是首选的组织制备方法。
