设为首页 | 加入收藏
| 欢迎光临本站!

消化内镜学分会官方网站

当前位置:文献追踪 > 国内外期刊

一项关于用不用针芯EUS-FNA的的单盲法随机对照前瞻性试验

发布日期:2014-1-29 12:40:12 文章来源:GIE(July,2011) 作者次数:1351
    一项关于用不用针芯EUS-FNA的的单盲法随机对照前瞻性试验
     
    背景
    在內镜超声引导下细针穿刺活检(EUS-FNA)时,多数內镜超声师会使用一枚内有针芯的EUS针。每次穿过针后再往针孔里插入针芯,这样不仅繁琐费时,而且没有资料显示它可以提高细胞标本质量。
     
    目的
    比较带针芯与不带针芯EUS-FNA所获得的标本:(1)细胞结构完整度,充分性,污染程度和血液量。(2)恶性肿瘤诊断率。
     
    设计方案
    具有前瞻性的单盲法随机对照试验。
     
    环境
    两个三级护理转诊中心(Two tertiary care referral centers)
     
    患者
    接受EUS-FNA诊断的实性病变患者。
     
    干涉
    接受EUS-FNA诊断的实性病变患者中,每人被穿刺两次,一次带针芯,一次不带针芯。穿刺顺序是随机的,而且观测幻灯片的细胞病理学家们都事先不了解针芯穿刺状况。
    主要评价指标
    标本细胞结构完整度,充足率,污染程度,血液量及恶性肿瘤诊断率。
     
    结果
    最终共分析101例患者,他们有118个病灶。每人被细针穿刺活检术(FNA)穿刺两次,一次带针芯,一次不带针芯,所以共穿刺236次。带针芯与不带针芯穿刺所获得的标本相比,其细胞结构(P = 0.98)、充分性(P = 0.26)、污染程度(P = 0.92)、有重要意义的血液量(P =0 .61),这些都没统计学差异。同时带针芯组中,恶性肿瘤诊断量为55,占236个标本的23%;不带针芯组中,恶性肿瘤诊断量为66,占236个标本的28%。
     
    局限性
    內镜超声师了解针穿刺状况。
     
    结论
    內镜超声引导下细针穿刺活检(EUS-FNA)期间,使用针芯穿刺并不会使所获得标本质量明显改善,也不会使肿瘤诊断率大幅提高。
     
    缩写:EUS-FNA为內镜超声引导下细针穿刺活检.
     
     
    --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
     
    A prospective, single-blind, randomized, controlled trial of EUS-guided FNA with and without a stylet
     
    Background
    Most endosonographers use an EUS needle with an internal stylet during EUS-guided FNA (EUS-FNA). Reinserting the stylet into the needle after every pass is tedious and time-consuming, and there are no data to suggest that it improves the quality of the cytology specimen.
     
    Objective
    To compare the samples obtained by EUS-FNA with and without a stylet for (1) the degree of cellularity, adequacy, contamination, and amount of blood and (2) the diagnostic yield of malignancy.
     
    Design
    Prospective,single-blind, randomized, controlled trial.
     
    Setting
    Two tertiary care referral centers.
     
    Patients
    Patients referred for EUS-FNA of solid lesions.
     
    Intervention
    Patients underwent EUS-FNA of the solid lesions, and 2 passes each were made with a stylet and without a stylet in the needle. The order of the passes was randomized, and the cytopathologists reviewing the slides were blinded to the stylet status of passes.
     
    Main Outcome Measurements
    Degree of cellularity, adequacy, contamination, amount of blood, and the diagnostic yield of malignancy in the specimens.
     
    Results
    A total of 101 patients with 118 lesions were included in final analysis; 236 FNA passes were made, each with and without a stylet. No significant differences were seen in the cellularity (P = .98), adequacy of the specimen (P = .26), contamination (P = .92), or significant amount of blood (P = .61) between specimens obtained with and without a stylet. The diagnostic yield of malignancy was 55 of 236 specimens (23%) in the with-stylet group compared with 66 of 236 specimens (28%) in the without-stylet group (P = .29).
     
    Limitations
    Endosonographers were not blinded to the stylet status of the passes.
     
    Conclusions
    Using a stylet during EUS-FNA does not confer any significant advantage with regard to the quality of the specimen obtained or the diagnostic yield of malignancy.
     
    Abbreviation: EUS-FNA, EUS-guided FNA
     
    (作者:)
相关评论
用户名: 登录