内镜超声引导下胰腺恶性肿瘤组织获取：一项三级中心的回顾性研究

Endoscopic Ultrasound-guided Tissue Acquisition of Pancreatic Malignancy: A Retrospective Study at a Tertiary Center.

作者信息

Constantinescu Alexandru, Pavel Christopher, Plotogea Oana-Mihaela, Andronic Octavian, Pușcașu Andreea, Gherghiceanu Florentina, Stan-Ilie Mădălina Cristina, Șandru Vasile

机构信息

Department of Gastroenterology, University Emergency Hospital Bucharest, 050098, Bucharest, Romania.

"Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.

出版信息

Rom J Intern Med. 2025 Apr 22;63(2):175-184. doi: 10.2478/rjim-2025-0008. eCollection 2025 Jun 1.

DOI:10.2478/rjim-2025-0008

PMID:40262059

Abstract

BACKGROUND

Endoscopic ultrasound (EUS) is gaining ground in today's diagnostic routine due to its ability to provide dynamic, accurate representations, but mostly because it facilitates tissue sampling amenable to histopathologic studies. Our main objective was to assess the accuracy of sampling pancreatic malignancies through EUS-fine-needle aspiration (FNA) compared to EUS-fine-needle biopsy (FNB) at a tertiary referral center, where rapid on-site evaluation (ROSE) for EUS-FNA is not available.

MATERIAL AND METHODS

A retrospective, 5-year analysis of all EUS-guided tissue acquisitions of pancreatic masses suggestive of neoplasia was performed. Out of the 484 patients who initially underwent non-invasive imaging studies, 401 subjects were ultimately confirmed as malignant using EUS-FNA/FNB or surgery.

RESULTS

Overall, the accuracy of EUS-guided sampling was 91%. There were 36 patients (9%) with false-negative results after EUS, who were further addressed to surgery and confirmed with pancreatic malignancy. Cytological and histological examinations found that FNB was significantly higher than FNA regarding the diagnostic yield (91.3% vs. 84.1%; p-value<0.05). Moreover, FNB required fewer needle punctures than FNA to achieve a definitive diagnosis (1.63 vs. 1.99; p-value<0.05).

CONCLUSIONS

Diagnostic management of pancreatic malignancies is unequivocally improved by FNB needles, rendering an improved tissue acquisition at a lower number of passes.

摘要

背景

内镜超声（EUS）在当今的诊断流程中越来越受到重视，这是因为它能够提供动态、准确的图像，更主要的是它便于获取适合组织病理学研究的组织样本。我们的主要目的是在一家三级转诊中心评估超声内镜引导下细针穿刺抽吸活检（EUS-FNA）与超声内镜引导下细针活检（EUS-FNB）对胰腺恶性肿瘤取样的准确性，该中心无法进行EUS-FNA的快速现场评估（ROSE）。

材料与方法

对所有超声内镜引导下对疑似肿瘤的胰腺肿块进行组织采集的病例进行了一项为期5年的回顾性分析。在最初接受非侵入性影像学检查的484例患者中，最终有401例通过EUS-FNA/FNB或手术确诊为恶性肿瘤。

结果

总体而言，超声内镜引导下取样的准确率为91%。有36例患者（9%）在接受EUS检查后出现假阴性结果，这些患者随后接受了手术，并被确诊为胰腺恶性肿瘤。细胞学和组织学检查发现，FNB的诊断率显著高于FNA（91.3%对84.1%；p值<0.05）。此外，FNB在获得明确诊断时所需的穿刺次数少于FNA（1.63次对1.99次；p值<0.05）。