Faigel D O, Ginsberg G G, Bentz J S, Gupta P K, Smith D B, Kochman M L
Department of Medicine, University of Pennsylvania Health System, Philadelphia, USA.
J Clin Oncol. 1997 Apr;15(4):1439-43. doi: 10.1200/JCO.1997.15.4.1439.
Endoscopic ultrasound (EUS) is an important new tool in the staging of pancreatic malignancies. Using new curved linear-array instruments, real-time fine-needle aspiration biopsy (RTFNA) of pancreatic lesions can be performed.
Forty-five patients with pancreatic lesions (22 males and 23 females) underwent staging with the Olympus EUM-20 (Olympus America Corp, Melville, NY) followed by EUS-RTFNA with the Pentax FG-32PUA (Pentax-Precision Instrument Corp, Orangeburg, NY) and the 22-gauge GIP needle (GIP Medizin Technik, Grassau, Germany).
EUS tumor stages were as follows: TO, n = 1; T1, n = 8; T2, n = 9; and T3 n = 27. Aspiration attempts were unsuccessful in four patients (two technical failures and two inadequate specimens). The remaining 41 lesions (mean size, 3.3 cm) were aspirated under EUS guidance (median passes, three) and the cytologic diagnoses were 25 definite adenocarcinoma, five suspicious for adenocarcinoma (three subsequently confirmed and two clinical course consistent with adenocarcinoma), and 11 negative for malignancy. Of 11 negatives, two were found to have adenocarcinoma, seven were confirmed benign at surgery (four cystadenomas and three inflammatory), one had a benign pseudocyst, and one had abundant inflammatory cells on RTFNA and follow-up time greater than 12 months with computed tomographic (CT) scans consistent with resolving inflammation. There were no false-positive RTFNAs. There were no procedure-related complications. Among those with diagnostic EUS-RTFNA (91%), the sensitivity for malignancy (confirmed plus suspicious) was 94% and negative predictive value 82%.
EUS-guided RTFNA is a safe and accurate method for performing pancreatic biopsy. It should be considered in patients with suspected pancreatic malignancies in whom a tissue diagnosis is required or when other modalities have failed. EUS-RTFNA allows for local staging and tissue diagnosis in one procedure.
内镜超声（EUS）是胰腺恶性肿瘤分期的一项重要新工具。使用新型弯曲线阵探头，可以对胰腺病变进行实时细针穿刺活检（RTFNA）。
45例胰腺病变患者（男性22例，女性23例）先使用奥林巴斯EUM-20（奥林巴斯美国公司，纽约州梅尔维尔）进行分期，随后使用宾得FG-32PUA（宾得精密仪器公司，纽约州奥兰治堡）和22G的GIP针（GIP医疗技术公司，德国格拉绍）进行EUS-RTFNA。
EUS肿瘤分期如下：T0，1例；T1，8例；T2，9例；T3，27例。4例患者穿刺失败（2例技术原因，2例标本不足）。其余41个病变（平均大小3.3 cm）在EUS引导下进行穿刺（中位穿刺次数3次），细胞学诊断为25例确诊腺癌，5例疑为腺癌（3例随后确诊，2例临床病程符合腺癌），11例恶性为阴性。在11例阴性病例中，2例发现为腺癌，7例手术证实为良性（4例囊腺瘤，3例炎症），1例为良性假性囊肿，1例RTFNA时有大量炎症细胞，随访超过12个月，计算机断层扫描（CT）显示炎症消退。RTFNA无假阳性。无操作相关并发症。在诊断性EUS-RTFNA患者中（91%），恶性肿瘤（确诊加可疑）的敏感性为94%，阴性预测值为82%。
EUS引导下的RTFNA是一种安全、准确的胰腺活检方法。对于需要组织学诊断或其他检查方法失败的疑似胰腺恶性肿瘤患者，应考虑使用该方法。EUS-RTFNA可在一次操作中实现局部分期和组织诊断。
