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內镜超声引导下细针穿刺活检术检测胰腺囊肿病变难以提供充足的用于细胞学和实验室分析的材料:预期研究结果

发布日期:2014-1-29 12:40:11 文章来源:Endoscopy 作者次数:1226
    內镜超声引导下细针穿刺活检术检测胰腺囊肿病变难以提供充足的用于细胞学和实验室分析的材料:预期研究中的初步结果
     
    K.       de Jong1, J.-W.  Poley2, J.  E.  van Hooft1, M.  Visser3, M.  J.  Bruno2, P.  Fockens1
    1荷兰阿姆斯特丹,荷兰阿姆斯特丹大学学术医疗中心胃肠病学和肝病学
    2荷兰鹿特丹大学医学中心,伊拉斯谟大学西校区胃肠病学和肝病学系
    3荷兰阿姆斯特丹大学学术医疗中心病理学系
     
    背景与研究目的:
    內镜超声引导下细针穿刺活检术(EUS-FNA)是一种既有价值又安全的深度调查胰腺囊肿损伤的技术。对內镜超声引导下细针穿刺活检准确度的预期研究中,我们对穿刺径路,样品充足性,并发症的初步科学结果做了报告。
    患者和方法:
    对不定性胰腺囊性病变患者实施內镜超声术和內镜超声引导下细针穿刺活检术,收集胰腺囊液,以备分析细胞病理和测量淀粉酶,癌胚抗原(CEA), 糖类抗原19.9 (CA 19.9) 含量水平。这个分析主要指标参数是细胞学与实验室分析用的充足的样品百分比。
    结果:
    实施內镜超声术的143例患者(平均年龄63岁,囊肿平均尺寸2.8cm)中有128例接受了细针穿刺活检术(90%),未做细针穿刺活检术的原因有很多种,包括传感器与胞囊病变处之间的距离太远(n = 9),囊肿看不见或太小(n=2),以及明显诊断出不应进行细针穿刺活检术(n = 3)。四例患者不可能进行细针穿刺活检术(技术故障)。送去细胞学分析的囊液仅提供了44例患者的细胞材料,占预期诊断量的 31 % (44/143)。68例患者提供了用于生物化学分析的充足液体(49%)。三例患者出现并发症(2.4%)。
    结论:
    尽管在技术上內镜超声引导下细针穿刺活检术对多数胰腺囊肿损伤患者诊断来说是行的通的(87%),但实际上在细胞病理学分级诊断和化学分析上仅仅可能分别达到为1/3,1/2。
     
    Original article
     
    Endoscopy 2011; 43(7): 585-590
    DOI: 10.1055/s-0030-1256440

    © Georg Thieme Verlag KG Stuttgart · New York
     
     
    Endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions provides inadequate material for cytology and laboratory analysis: initial results from a prospective study
     
    K.  de Jong1, J.-W.  Poley2, J.  E.  van Hooft1, M.  Visser3, M.  J.  Bruno2, P.  Fockens1
    1 Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
    2 Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
    3 Department of Pathology, Academic Medical Center, Amsterdam, University of Amsterdam, The Netherlands

    Background and study aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is considered a valuable and safe technique for further investigation of pancreatic cystic lesions. In the framework of a prospective study on the accuracy of EUS-FNA we report our initial technical results regarding puncture access, sample adequacy, and complications

    Patients and methods: Consecutive patients with indeterminate pancreatic cystic lesions underwent EUS and EUS-FNA. Pancreatic cyst fluid was collected for cytopathological analysis and measurement of amylase, carcinoembryonic antigen (CEA), and carbohydrate antigen 19.9 (CA 19.9) levels. Main outcome parameter for this analysis was the percentage of samples adequate for cytologic and laboratory analysis.

    Results: Of 143 patients (median age 63 years; median cyst size 2.8 cm) who underwent EUS, FNA was performed in 128 (90 %). The various reasons for not doing FNA included large distance between transducer and cystic lesion (n = 9), cyst not seen or too small (n = 2), and evident diagnosis not requiring FNA (n = 3). FNA was not possible in four patients (technical failures). Cyst fluid sent for cytology provided adequate cellular material in 44 cases only, accounting for an intention-to-diagnose yield of 31 % (44/143). Sufficient fluid for biochemical analysis was obtained in 68 cases (49 %). Complications occurred in three patients (2.4 %).

    Conclusions: Although EUS-guided FNA was technically feasible in the majority of patients with pancreatic cystic lesions (87 %), it was possible to obtain a classifying cytopathologic diagnosis and a chemical analysis in only a third and a half of cases, respectively.

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