Zhou Yuyan, Sun Liqi, Wang Xinyue, Wan Dongling, Xu Jiaheng, Jiang Mengruo, Liu Yue, Liu Chao, Tu Yatao, Huang Haojie, Jin Zhendong
Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Changhai Hospital; and National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China.
Endosc Ultrasound. 2024 Nov-Dec;13(6):351-360. doi: 10.1097/eus.0000000000000095. Epub 2024 Dec 17.
EUS is recommended for guiding pancreatic tissue acquisition in suspected autoimmune pancreatitis (AIP) cases. However, there is a lack of comparative research on the effectiveness between EUS-guided fine-needle aspiration (EUS-FNA) and EUS-guided fine-needle biopsy (EUS-FNB) for diagnosing AIP in China. This study aimed to evaluate the diagnostic accuracy of EUS-guided tissue acquisition (EUS-TA) specifically for type 1 AIP.
Between 2010 and 2023, individuals with AIP who received EUS-TA at Changhai Hospital were included in the study.
A total of 173 patients diagnosed with AIP who underwent EUS-TA were included in the final analysis. Of these, 104 patients (60.1%) received EUS-FNA, and 69 patients (39.9%) underwent EUS-FNB. Sufficient pancreatic tissue samples (>5 cells/high-power field) were obtained in 164 of 173 patients (94.8%), with success rates of 94.2% for EUS-FNA and 95.7% for EUS-FNB ( 0.05). EUS-FNB exhibited higher rates of reliable level 1 histopathological findings (40.9% 16.3%, < 0.001) and reliable level 2 histopathological findings (33.3% . 12.2%, < 0.001) compared with EUS-FNA. Furthermore, a higher occurrence of IgG4-positive plasma cell infiltration (>10 cells/high-power field) was observed with EUS-FNB compared with EUS-FNA (74.2% . 27.9%, < 0.001). The multivariate logistic analysis also revealed that EUS-FNA was less effective in obtaining reliable evidence compared with EUS-FNB, as evident in both level 2 ( = 0.002; odds ratio, 0.21; 95% confidence interval, 0.08-0.56) and level 1 ( = 0.001; odds ratio, 0.19; 95% confidence interval, 0.08-0.49) histopathological evidence.
EUS-FNB demonstrates higher rates of level 1 and level 2 histopathological findings, as well as more abundant IgG4-positive plasma cell infiltration, compared with EUS-FNA.
超声内镜引导下细针穿刺抽吸术（EUS-FNA）和超声内镜引导下细针活检术（EUS-FNB）在疑似自身免疫性胰腺炎（AIP）病例的胰腺组织获取中都具有重要作用。然而，在中国，对于EUS-FNA和EUS-FNB诊断AIP的有效性缺乏比较研究。本研究旨在评估超声内镜引导下组织获取术（EUS-TA）对1型AIP的诊断准确性。
纳入2010年至2023年期间在上海长海医院接受EUS-TA的AIP患者。
最终分析纳入了173例接受EUS-TA诊断为AIP的患者。其中，104例（60.1%）接受了EUS-FNA，69例（39.9%）接受了EUS-FNB。173例患者中有164例（94.8%）获得了足够的胰腺组织样本（>5个细胞/高倍视野），EUS-FNA的成功率为94.2%，EUS-FNB的成功率为95.7%（P>0.05）。与EUS-FNA相比，EUS-FNB的可靠组织病理学1级发现率更高（40.9%对16.3%，P<0.001），可靠组织病理学2级发现率更高（33.3%对12.2%，P<0.001）。此外，与EUS-FNA相比，EUS-FNB观察到IgG4阳性浆细胞浸润（>10个细胞/高倍视野）的发生率更高（74.2%对27.9%，P<0.001）。多因素逻辑分析还显示，与EUS-FNB相比，EUS-FNA在获得可靠证据方面效果较差，在组织病理学2级证据（P=0.002；优势比，0.21；95%置信区间，0.08-0.56）和1级证据（P=0.001；优势比，0.19；95%置信区间，0.08-0.49）中均有体现。
与EUS-FNA相比，EUS-FNB的组织病理学1级和2级发现率更高，IgG4阳性浆细胞浸润更丰富。
