Hünerbein M, Dohmoto M, Haensch W, Schlag P M
Virchow Klinik, Robert Rössle Hospital and Tumor Institute, Humboldt University, Berlin, Germany.
Endoscopy. 1998 Jan;30(1):32-6. doi: 10.1055/s-2007-993725.
Although endoscopic ultrasound (EUS) allows sensitive imaging of the upper gastrointestinal (GI) tract, it remains difficult to differentiate between benign and malignant lesions on the basis of ultrasound morphology. The purpose of this study was to determine the value of EUS-guided biopsy for the diagnosis of submucosal and extraluminal tumors.
EUS-guided biopsy was carried out in 50 patients with upper GI-tract lesions. All patients were examined using a flexible echoendoscope with a 5/7.5 MHz curved array transducer. A specially designed biopsy device (type Vilmann) with a fine needle (diameter 0.8 mm) was used for EUS-guided biopsy.
EUS-guided biopsy was performed for evaluation of mediastinal lesions (n = 15), pancreatic tumors (n = 26) and submucosal (n = 5) or stenotic tumors of the esophagus (n = 4). Fine-needle aspiration yielded diagnostic tissue samples in 44 of 50 patients (88%). Histology demonstrated benign lesions in 20 of 44 patients and malignant tumors in the other 24 patients. EUS-guided biopsy failed in only six patients (12%): in four patients it was impossible to advance the needle into very hard pancreatic tumors; non-representative biopsy material was obtained in two further cases. The results of EUS-guided biopsy were validated by surgery (n = 21), autopsy (n = 3) or clinical follow-up (n = 20). After a mean follow-up of 16 months there is no evidence of malignancy in any of the patients with benign histology. The sensitivity and specificity of EUS-guided biopsy in the diagnosis of malignancy were 88% and 100%, respectively. None of the patients experienced complications related to endosonographic biopsy.
EUS-guided biopsy with the Vilmann needle device is a safe and accurate method for tissue sampling of extraluminal lesions. This technique considerably improves the diagnostic value of endosonography.
尽管内镜超声（EUS）能够对上消化道（GI）进行灵敏成像，但基于超声形态学来区分良性和恶性病变仍很困难。本研究的目的是确定EUS引导下活检对诊断黏膜下和腔外肿瘤的价值。
对50例上消化道病变患者进行EUS引导下活检。所有患者均使用配备5/7.5 MHz弯曲阵列换能器的可弯曲超声内镜进行检查。采用一种专门设计的带有细针（直径0.8 mm）的活检装置（Vilmann型）进行EUS引导下活检。
EUS引导下活检用于评估纵隔病变（n = 15）、胰腺肿瘤（n = 26）以及食管黏膜下（n = 5）或狭窄性肿瘤（n = 4）。50例患者中有44例（88%）通过细针穿刺获得了诊断性组织样本。组织学检查显示，44例患者中有20例为良性病变，另外24例为恶性肿瘤。EUS引导下活检仅在6例患者（12%）中失败：4例患者无法将针推进非常坚硬的胰腺肿瘤中；另外2例获得的活检材料不具有代表性。EUS引导下活检的结果通过手术（n = 21）、尸检（n = 3）或临床随访（n = 20）得到验证。平均随访16个月后，组织学为良性的患者均无恶性病变证据。EUS引导下活检诊断恶性病变的敏感性和特异性分别为88%和100%。所有患者均未发生与内镜超声活检相关的并发症。
使用Vilmann针装置进行EUS引导下活检是一种安全、准确的腔外病变组织采样方法。该技术显著提高了内镜超声的诊断价值。
