Gress F G, Hawes R H, Savides T J, Ikenberry S O, Lehman G A
Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis 46202, USA.
Gastrointest Endosc. 1997 Mar;45(3):243-50. doi: 10.1016/s0016-5107(97)70266-9.
Endoscopic ultrasound (EUS) accurately stages gastrointestinal malignancies but is less able to differentiate between neoplastic and inflammatory processes. EUS-guided fine-needle aspiration (EUS FNA) has been reported useful for obtaining a diagnosis in suspected gastrointestinal lesions. We report our entire experience with EUS FNA using both radial and linear array endosonography, including our diagnostic accuracy and complication rate.
Two hundred eight consecutive patients (119 men, 89 women) referred for EUS evaluation of suspected gastrointestinal or mediastinal masses underwent EUS-guided FNA. We performed EUS FNA using radial scanning or linear array endosonography and a 23 gauge, 4 cm needle or a 22 gauge, 12 cm needle. Data collected included lesion types, number of passes, complications, and diagnostic accuracy.
Two hundred eight lesions were targeted, with a total of 705 FNA passes (mean 3.39 passes/patient). Overall diagnostic accuracy for our study population was 87% with a 89% sensitivity and 100% specificity. The diagnostic accuracy for each subgroup was 95% for mediastinal lymph node, 85% for intra-abdominal lymph node, 85% for pancreatic, 84% for submucosal, and 100% for perirectal masses. EUS FNA provided an adequate specimen in 90% of patients. The FNA results were similar for both types of endosonography. We observed immediate complications in 2% (4 of 208) of patients. All complications occurred with EUS FNA of pancreatic lesions and consisted of bleeding and pancreatitis in 2 patients each. For EUS FNA of pancreatic masses there was a 1.2% (2 of 121) risk of pancreatitis, 1% (1/121) risk of severe bleeding, and risk of death in less than 1%.
EUS-guided FNA appears to be technically feasible, safe, and accurate for obtaining diagnostic tissue of suspicious gastrointestinal and mediastinal lesions and provides important preoperative information.
内镜超声（EUS）能准确对胃肠道恶性肿瘤进行分期，但区分肿瘤性和炎性病变的能力较弱。据报道，EUS引导下细针穿刺抽吸术（EUS FNA）有助于对疑似胃肠道病变作出诊断。我们报告了使用径向和线性阵列超声内镜进行EUS FNA的全部经验，包括诊断准确性和并发症发生率。
连续208例因疑似胃肠道或纵隔肿物接受EUS评估的患者接受了EUS引导下FNA。我们使用径向扫描或线性阵列超声内镜以及23号4厘米针或22号12厘米针进行EUS FNA。收集的数据包括病变类型、穿刺次数、并发症和诊断准确性。
共对208个病变进行了穿刺，总共进行了705次FNA穿刺（平均每位患者3.39次）。研究人群的总体诊断准确性为87%，敏感性为89%，特异性为100%。各亚组的诊断准确性分别为：纵隔淋巴结95%、腹内淋巴结85%、胰腺85%、黏膜下84%、直肠周围肿物100%。90%的患者通过EUS FNA获得了足够的标本。两种超声内镜检查的FNA结果相似。我们观察到2%（208例中的4例）的患者出现即时并发症。所有并发症均发生在胰腺病变的EUS FNA过程中，2例患者出现出血，2例患者出现胰腺炎。对于胰腺肿物的EUS FNA，胰腺炎风险为1.2%（121例中的2例），严重出血风险为1%（1/121），死亡风险小于1%。
EUS引导下FNA在获取可疑胃肠道和纵隔病变的诊断性组织方面似乎在技术上可行、安全且准确，并能提供重要的术前信息。
