Di Stasi M, Lencioni R, Solmi L, Magnolfi F, Caturelli E, De Sio I, Salmi A, Buscarini L
Gastroenterology Division, Hospital of Piacenza, Italy.
Am J Gastroenterol. 1998 Aug;93(8):1329-33. doi: 10.1111/j.1572-0241.1998.443_m.x.
The aim of this study was to investigate the results of ultrasound-guided fine needle biopsy of pancreatic masses in a large multicenter series.
This study collected the data of 510 patients who had a final diagnosis available and who had undergone ultrasound-guided fine needle biopsy of the pancreas. Retrieval rate, sensitivity, specificity, and overall diagnostic accuracy of the whole series, by three different bioptic procedures (cytology, histology, and cytology plus histology) were evaluated. The reliability of ultrasound-guided fine needle biopsy to allow a correct diagnosis in the different pancreatic pathologies was calculated. Finally, any complications were collected.
For cytology, histology, and cytology plus histology, retrieval rate values were: 94%, 96%, and 97%; sensitivity was: 87%, 94%, and 94%, specificity: 100%; and diagnostic accuracy: 91%, 90%, and 95%, respectively. Ultrasound-guided fine-needle biopsy correctly diagnosed all the cases of pancreatic metastases or non-Hodgkin's lymphoma (23 of 510 cases as 5%; in eight of 23 it led to the first diagnosis of the primary tumor) and all the cases of abscesses, 97% of the cases of pseudocysts, 86% of pancreatic adenocarcinomas, 62% of cystic neoplasms, 35% of the cases of chronic pancreatitis (in this case, the bioptic procedures were reviewed), and 33% of neuroendocrine tumors. There were complications in one case of asymptomatic peripancreatic hematoma, three cases of vaso-vagal reactions, and 21 cases of pain.
Ultrasound-guided fine needle biopsy of the pancreas is efficacious, without any difference between the various bioptic modalities (with the exception of chronic pancreatitis, in which histology is better). The technique is safe. Moreover, the procedure allows the identification of patients affected by pancreatic tumors other than adenocarcinoma (in our survey 5% of the total); in about one third of these patients it leads to the diagnosis of the primary tumor, thus avoiding inappropriate treatments.
本研究旨在调查在一个大型多中心系列中超声引导下胰腺肿块细针穿刺活检的结果。
本研究收集了510例最终确诊且接受过胰腺超声引导下细针穿刺活检患者的数据。评估了整个系列通过三种不同活检程序（细胞学、组织学以及细胞学加组织学）的取材率、敏感性、特异性和总体诊断准确性。计算了超声引导下细针穿刺活检在不同胰腺病变中做出正确诊断的可靠性。最后，收集了所有并发症情况。
对于细胞学、组织学以及细胞学加组织学，取材率分别为：94%、96%和97%；敏感性分别为：87%、94%和94%，特异性均为100%；诊断准确性分别为：91%、90%和95%。超声引导下细针穿刺活检正确诊断了所有胰腺转移瘤或非霍奇金淋巴瘤病例（510例中的23例，占5%；23例中有8例由此首次诊断出原发肿瘤）以及所有脓肿病例、97%的假性囊肿病例、86%的胰腺腺癌病例、62%的囊性肿瘤病例、35%的慢性胰腺炎病例（对于该病例，重新审查了活检程序）以及33%的神经内分泌肿瘤病例。出现了1例无症状的胰周血肿、3例血管迷走神经反应以及21例疼痛等并发症。
胰腺超声引导下细针穿刺活检是有效的，各种活检方式之间无差异（慢性胰腺炎除外，组织学活检效果更佳）。该技术是安全的。此外，该操作能够识别出除腺癌外患有胰腺肿瘤的患者（在我们的调查中占总数的5%）；在这些患者中约三分之一可由此诊断出原发肿瘤，从而避免不恰当的治疗。
