Cheng Bingqian, Du Chen, He Zhengting, Feng Xiuxue, Li Huikai, Wang Zhanbo, Gao Fei, Zhao Yunyun, Chai Ningli, Linghu Enqiang
Medical School of Chinese PLA, 100853 Beijing, China.
Department of Gastroenterology, the First Medical Center, Chinese PLA General Hospital, Beijing 100083, China.
Endosc Ultrasound. 2024 Nov-Dec;13(6):345-350. doi: 10.1097/eus.0000000000000091. Epub 2024 Dec 10.
An accurate diagnosis is crucial for the clinical management of pancreatic cystic neoplasm (PCN). EUS-guided through-the-needle biopsy (EUS-TTNB) is a novel technique for improving the accuracy of PCN diagnosis. There is insufficient evidence about the efficacy of EUS-TTNB. This study aims to evaluate the feasibility and diagnostic performance of EUS-TTNB for PCN.
Between June 2015 and July 2023, we prospectively enrolled 454 patients with a clinical concern for PCN in our database. After excluding those diagnosed with pancreatic cancer, pseudocysts, or other no-neoplasms, we assessed 326 patients with 329 cysts undergoing EUS-guided fine-needle-aspiration (EUS-FNA) or EUS-TTNB for evaluation. The primary indicators were tissue acquisition yield and diagnostic yield. The cyst characteristics (size, location, the presence of septation, mural nodule, and solid mass) and the number of biopsy samples were chosen for the analysis of factors associated with diagnostic performance.
There were 220 (67.5%) females and 106 (32.5%) males, and the median patient age was 50 years (range, 18-88). There were 329 cysts sampled by FNA and 143 by TTNB. The median cyst size was 31.5 mm (range, 6.9-114.0). The diagnostic yields of FNA and TTNB were 35.7% (112/314) and 57.5% (73/127), respectively ( < 0.001). Special cyst types were diagnosed by TTNB in 58 (45.7%, 58/127) cysts, 19 of which had surgical pathology. Fifteen of 19 TTNB diagnoses were concordant with the surgical pathology.
EUS-TTNB is an option to improve the diagnosis of PCN. Standardized procedures and appropriate indications for TTNB need to be studied.
准确诊断对于胰腺囊性肿瘤（PCN）的临床管理至关重要。超声内镜引导下经针穿刺活检（EUS-TTNB）是一种提高PCN诊断准确性的新技术。关于EUS-TTNB疗效的证据不足。本研究旨在评估EUS-TTNB对PCN的可行性和诊断性能。
2015年6月至2023年7月，我们前瞻性地将454例临床上关注PCN的患者纳入我们的数据库。在排除那些被诊断为胰腺癌、假性囊肿或其他非肿瘤性疾病的患者后，我们评估了326例患者的329个囊肿，这些囊肿接受了超声内镜引导下细针穿刺抽吸（EUS-FNA）或EUS-TTNB以进行评估。主要指标是组织获取率和诊断率。选择囊肿特征（大小、位置、分隔、壁结节和实性肿块的存在）和活检样本数量进行与诊断性能相关因素的分析。
有220例（67.5%）女性和106例（32.5%）男性，患者中位年龄为50岁（范围18 - 88岁）。通过FNA采样的囊肿有329个，通过TTNB采样的有143个。囊肿中位大小为31.5毫米（范围6.9 - 114.0）。FNA和TTNB的诊断率分别为35.7%（112/314）和57.5%（73/127）（<0.001）。TTNB在58个（45.7%，58/127）囊肿中诊断出特殊囊肿类型，其中19个有手术病理结果。19例TTNB诊断中有15例与手术病理结果一致。
EUS-TTNB是改善PCN诊断的一种选择。需要研究TTNB的标准化程序和合适的适应证。
