Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 704, Taiwan.
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Dig Dis Sci. 2024 Nov;69(11):4302-4310. doi: 10.1007/s10620-024-08691-4. Epub 2024 Oct 24.
Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is highly accurate for diagnosing pancreatic mass. However, making diagnosis is challenging in 5-20% of patients. This study investigated the challenging features associated with reduced diagnostic performance in EUS-FNB and potential rescue methods that can improve the diagnostic rate.
This single-center retrospective study included patients with solid pancreatic tumors who underwent EUS-FNB between January 1, 2019, and December 12, 2021. Patients without a computed tomography (CT) scan or definite diagnosis were excluded. Challenging features were features that reduced diagnostic accuracy in EUS-FNB, as determined through multivariate analysis. Rescue methods were methods that assisted operators in assessing lesions in patients with challenging features.
Of 332 enrolled patients, an accurate diagnosis obtained using EUS-FNB was achieved in 286 (86.1%). Univariable analysis revealed that the diagnostic accuracy was lower in cases of pancreatic tumors with isoattenuation in CT images (77.3% vs. 89.8%, odds ratio [OR]: 0.39, p = 0.003), an ill-defined margin on EUS (61.2% vs. 92.5%, OR: 0.13, p < 0.001), or tumor size < 20 mm (65.5% vs. 88.1%, OR: 0.26, p = 0.002). However, only ill-defined margins on EUS (OR: 0.14, p < 0.001) and tumor size < 20 mm (OR: 0.25, p = 0.005) were independent predictors of inconclusive EUS-FNB in the multivariate analysis. The use of contrast (OR: 4.46, p = 0.026) and a highly experienced endosonographer (> 5cases/month; OR: 3.25, p = 0.034) improved diagnostic performance in difficult cases.
Pancreatic tumors with ill-defined tumor margins on EUS or size < 20 mm are challenging features in EUS-FNB. The use of contrast and a highly experienced endosonographer can improve diagnostic performance in difficult cases.
内镜超声引导下细针穿刺活检（EUS-FNB）对于诊断胰腺肿块非常准确。然而，在 5-20%的患者中，做出诊断具有挑战性。本研究调查了与 EUS-FNB 诊断性能降低相关的具有挑战性的特征，以及可能提高诊断率的潜在抢救方法。
这项单中心回顾性研究纳入了 2019 年 1 月 1 日至 2021 年 12 月 12 日期间接受 EUS-FNB 治疗的实性胰腺肿瘤患者。排除了没有 CT 扫描或明确诊断的患者。通过多变量分析确定，具有挑战性的特征是降低 EUS-FNB 诊断准确性的特征。抢救方法是帮助操作者评估具有挑战性特征的患者病变的方法。
在 332 名入组患者中，通过 EUS-FNB 获得了准确的诊断，286 名（86.1%）患者获得了准确的诊断。单变量分析显示，CT 图像上胰腺肿瘤等密度（77.3% vs. 89.8%，优势比[OR]：0.39，p=0.003）、EUS 上边界不清（61.2% vs. 92.5%，OR：0.13，p<0.001）或肿瘤直径<20mm（65.5% vs. 88.1%，OR：0.26，p=0.002）时，诊断准确性较低。然而，只有 EUS 上边界不清（OR：0.14，p<0.001）和肿瘤直径<20mm（OR：0.25，p=0.005）是多变量分析中 EUS-FNB 不确定结果的独立预测因素。使用对比剂（OR：4.46，p=0.026）和经验丰富的内镜超声医师（>5 例/月；OR：3.25，p=0.034）可提高困难病例的诊断性能。
EUS 上边界不清或直径<20mm 的胰腺肿瘤是 EUS-FNB 的具有挑战性的特征。使用对比剂和经验丰富的内镜超声医师可以提高困难病例的诊断性能。
