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EUS-FNA与荧光原位杂交补救诊断现场未确定细胞病理学结论的胰腺癌患者

发布日期:2014-1-29 12:40:19 文章来源:GIE 作者次数:1299
    背景
    目前我们采用荧光原位杂交(FISH)分析法对胰腺肿块细针穿刺活检(FNA)样本行染色体异常检测还没有深入研究。选用荧光原位杂交(FISH)对现场未确定细胞病理学结论的患者可能会提高超声內镜(EUS)对恶性肿瘤的敏感性。
    目的
    测定荧光原位杂交(FISH)分析法对现场未确定细胞病理学结论的患者的敏感性和特异性。
    设计
    本研究患者患有连续性疑似胰腺恶性肿瘤,且为非随机队列研究。最终的诊断结论是依据外科活检、长期随访期间的疾病进展情况或死亡来决定。
    环境
    学术中心和三级癌症转诊中心
    患者
    对206例胰腺实性病变患者实施212次为期24个月的內镜检查(2009年1月-2010年12月)。对69例现场未确定或无效细胞病理学结论的患者进行荧光原位杂交(FISH)分析。
    干预
    实性胰腺肿块的內镜超声引导下细针活检(EUS-FNA)以及3、7和17号染色体多体性和9p21缺失的细胞学和荧光原位杂交(FISH)分析。
    主要测量指标
    细胞学检查、荧光原位杂交(FISH)检查以及二者联合检查的敏感性/特异性。
    结果
    以下患者都不能进行研究:110例能被现场确定细胞学结论者,22例患神经内分泌肿瘤,1例随访者不足者,3例未被荧光原位杂交(FISH)检查以及有1例胰腺转移肾癌患者。本队列研究包含69例患者,其中54例患恶性肿瘤,15例患良性疾病。细胞学、荧光原位杂交(FISH)分析和二者联合分析对恶性肿瘤的敏感性分别为61%,74%和85%(P = 0.009)。荧光原位杂交(FISH)比细胞学多检测出13例胰腺癌患者,且它对15例良性疾病患者没有假阳性分析,也未发生EUS-FNA(內镜超声引导下细针穿刺活检)导致的严重并发症。
    局限性
    单中心研究,接受荧光原位杂交(FISH)分析的患者是挑选出来的,且良性疾病患者数量有限。
    结论
    荧光原位杂交(FISH)分析法能检测出细胞学检测不出的疑似胰腺癌案例,且不会降低特异性。当细胞学不确定已知胰腺肿块是否为恶性肿瘤时,应该考虑采用荧光原位杂交(FISH)分析法来检测3、7和17号染色体的多体性和9p21染色体的缺失情况。
    缩写词:DNA为脱氧核糖核苷酸,EUS-FNA为內镜超声引导下细针穿刺活检术,FISH为荧光原位杂交技术。
     
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    EUS-FNA with rescue fluorescence in situ hybridization for the diagnosis of pancreatic carcinoma in patients with inconclusive on-site cytopathology results
    Background
    Detection of chromosomal abnormalities by fluorescence in situ hybridization (FISH) analysis has not been well-studied in FNA samples of pancreatic masses. Selective use of FISH in patients with inconclusive on-site cytopathology results may improve the sensitivity of EUS for malignancy.
    Objective
    To determine the sensitivity and specificity of FISH analysis in patients with inconclusive on-site cytopathology results.
    Design
    Consecutive patients with suspected pancreatic malignancy, nonrandomized cohort study. Final diagnosis was based on either surgical biopsy or disease progression on extended follow-up or death.
    Setting
    Academic center, tertiary-care referral cancer center.
    Patients
    A total of 212 EUS examinations were performed in 206 patients for solid pancreatic lesions over a 24-month period (January 2009-December 2010). FISH analysis was done for 69 patients with inconclusive or nonavailable on-site cytology results.
    Intervention
    EUS-guided FNA (EUS-FNA) of solid pancreatic masses with cytology and FISH analysis for polysomy of chromosomes 3, 7, and 17 and deletion of 9p21.
    Main Outcome Measurements
    Sensitivity/specificity of cytology, FISH, and a composite of cytology and FISH.
    Results
    Patients with positive on-site cytology (110), neuroendocrine tumors (22), insufficient follow-up (1), FISH not obtained (3), and renal cancer with pancreatic metastasis (1) were excluded. Sixty-nine patients comprised the study cohort, 54 with malignancy and 15 with benign disease. Sensitivity for malignancy of cytology, FISH analysis, and the combination were 61%, 74%, and 85%, respectively (P = .009). FISH detected an additional 13 cases of pancreatic adenocarcinoma missed by cytology. There was no false-positive FISH analysis in 15 patients with benign disease. No major complications occurred from EUS-FNA.
    Limitations
    Single center, selected patients underwent FISH analysis, limited number of patients with benign disease.
    Conclusion
    In patients with suspected pancreatic cancer, FISH analysis can detect additional cases missed by cytology without compromising specificity. FISH analysis to detect polysomy of chromosomes 3, 7, and 17 and deletion of 9p21 should be considered when cytology is negative for malignancy in patients with a known pancreatic mass.
     
     
     
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