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用一枚19型号针对所选患者群行超声內镜引导下的细针组织获取术:一项前瞻性研究

发布日期:2014-1-29 12:40:18 文章来源:GIE 作者次数:1174

     

    背景
    內镜超声引导期间获取组织学测试所需组织标本的能力理论上优于单一细胞学。
    目的
    前瞻性评估用大直径针行內镜超声引导下细针组织获取(EUS-FNTA)的可行性和获取量,而且期望组织学比细胞学更利于对患者达成一个明确的诊断结论。
    设计
    前瞻性队列研究。
    环境
    of unknown origin, or pancreatic lesions after nondiagnostic FNA.
    患者
    非诊断性细针获取(FNA)后,患连续性上皮下病变食管-胃壁增厚纵膈和腹部肿块/原因不明的淋巴结病或者胰腺病变的患者。
    干预
    主要测量结果:
    內镜超声引导下细针组织获取(EUS-FNTA)的可行性和获取量。
    结果
    本研究共有120例患者参加,其中平均年龄为61 ± 14.6岁,平均病变组织尺寸为38 ± 25 mm(范围为8-140 mm)。对其他患者都成功实施细针组织获取(FNTA),但有1例未成功,成功率为98.9%,从119例患者中的116例(97.5%)获得足够组织学检查的标本,而技术上对119例患者成功实施內镜超声引导下细针组织获取。每例患者平均接受穿刺2.8 ± 0.8次。当前随访时,120例患者中对117例(97.5%)诊断明确,只有8例是假阴性。对明确诊断的117例患者行內镜超声引导下细针组织获取(EUS-FNTA),其敏感性、特异性、阳性预测值、阴性预测值和诊断准确度分别为91.8%、100%、100%、71.4%和93.2%
    局限性
    单中心研究且研究力量有限
    结论
    用一枚大型号针行超声內镜引导下的细针组织获取(EUS-FNTA)不仅有高的获取量,而且能达到希望的诊断准确度,因此当组织学比细胞学更有利于明确诊断时,我们可以采用这种方法。
    缩写词:CLA为常用线性阵列,EUS-FNA为超声內镜引导下细针穿刺术,EUS-FNTA为超声內镜引导下细针组织获取术,EUS-TCB为超声內镜引导下组织切割(Tru-Cut)活检针,FV为前视式,LQ下四分位值,UQ为上四分位值。
     
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    EUS-guided fine-needle tissue acquisition by using a 19-gauge needle in a selected patient population: a prospective study
    Background
    The ability to obtain tissue samples for histological examination during EUS has theoretical advantages over cytology alone.
    Objective
    To prospectively evaluate the feasibility and yield of EUS-guided fine-needle tissue acquisition (EUS-FNTA) with a large-gauge needle in patients in whom we expected histology to be more useful than cytology to reach a definitive diagnosis.
    Design
    Prospective cohort study.
    Setting
    Tertiary care academic medical center.
    Patients
    Consecutive patients with subepithelial lesions, esophagogastric wall thickening, mediastinal and abdominal masses/lymphadenopathy of unknown origin, or pancreatic lesions after nondiagnostic FNA.
    Interventions
    EUS-FNTA with a 19-gauge needle.
    Main Outcome Measurements
    Feasibility and yield of EUS-FNTA.
    Results
    A total of 120 patients with a mean age of 61 ± 14.6 years and mean lesion size of 38 ± 25 mm (range 8-140 mm) were enrolled. FNTA was successfully performed in all but 1 patient (98.9%), and adequate samples for histological examination were obtained in 116 of the 119 patients (97.5%) in whom EUS-FNTA was technically successful. A mean of 2.8 ± 0.8 passes per patient were performed. At the time of current follow-up, a definitive diagnosis was available in 117 of the 120 patients (97.5%), with only 8 false-negative results. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of EUS-FNTA in the 117 patients with a definitive diagnosis were 91.8%, 100%, 100%, 71.4%, and 93.2%, respectively.
    Limitations
    Single-center study with limited power.
    Conclusions
    EUS-FNTA by using a large-gauge needle has a high yield and promising diagnostic accuracy and could be used when histology may be more useful than cytology to reach a definitive diagnosis.
     
     
     
     
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