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超声内镜引导切割针穿刺活检结果对制定直径大于等于2厘米的胃皮下肿瘤治疗决策的临床影响

发布日期:2014-1-29 12:40:22 文章来源:GIE 作者次数:1287
    超声内镜引导切割针穿刺活检结果对制定直径大于等于2厘米的胃皮下肿瘤治疗决策的临床影响
     
    背景
    术前病理诊断胃皮下肿瘤(SET)可能会提高临床决策。.然而,关于超声内镜引导切割针穿刺活检(EUS - TCB)的数据对制定胃皮下肿瘤治疗决策的临床影响尚未评估。
     
    目的:
    .为了评估超声内镜引导切割针穿刺活检信息对胃皮下肿瘤患者的临床管理的影响。
     
    设计
    回顾性审查前瞻性收集的数据。
     
    环境
    三级转诊中心。
     
    患者
    65例直径大于或等于2cm的胃皮下肿瘤患者。
     
    干预
    超声内镜引导切割针穿刺活检
     
    主要结果测量
    由于超声内镜引导切割针穿刺活检的结果,所以患者数量发生了变化,并为其制定治疗计划。
     
    结果
    因为技术问题,9例皮下肿瘤患者没有被切割针穿刺活检的针头刺破,我们无法从19例皮下肿瘤患者获得足够的皮下组织。在65例患者中有18例治疗计划发生变化(27.7%)。 正是这些变化以致7例良性皮下肿瘤(直径≥3厘米)患者避免了不必要的切除且被安排确定性治疗(6例胃肠道间质瘤和1例类癌瘤)并被修改了术野(3例大胃肠道间质瘤和1例癌症)。相对于肿瘤的位置,当我们评估治疗方案时,我们发现避免不必要的手术切除与心脏皮下肿瘤存在关联。
     
    局限性
    少数患者的回顾性研究。
     
    结论
    在65例胃皮下肿瘤患者治疗决策中,有18例(27.7%)受超声内镜引导切割针穿刺活检改变或影响。根据由超声内镜引导切割针穿刺活检所诊断出的皮下肿瘤的大小和位置, 患者可以得到适当的和专门为其定制的手术,医学治疗或监护。
     

    缩写词:EUS-FNA为超声内镜引导下细针注射术;EUS-TCB为超声内镜引导切割针穿刺活检;GIST为胃肠道间质瘤;H&E为苏木精和曙红;IHC为免疫组织化学;SET为皮下肿瘤;TCB,为切割针穿刺活检。

     

    Clinical impact of EUS-guided Trucut biopsy results on decision making for patients with gastric subepithelial tumors ≥2 cm in diameter
    Background
    Preoperative pathologic diagnosis of a gastric subepithelial tumor (SET) may improve clinical decision making. However, the clinical impact of EUS-guided Trucut biopsy (EUS-TCB) data on decision making in patients with a gastric SET has not been assessed.
    Objective
    To evaluate the impact of EUS-TCB information on the clinical management of patients with a gastric SET.
    Design
    Retrospective review of prospectively collected data.
    Setting
    Tertiary referral center.
    Patients
    Sixty-five patients with gastric SETs 2 cm or larger in diameter.
    Intervention
    EUS-TCB.
    Main Outcome Measurements
    The number of patients for whom treatment plans were changed because of EUS-TCB results.
    Results
    Nine SETs were not punctured by the TCB needle because of technical problems, and we were unable to obtain adequate subepithelial tissue from 19 SETs. Treatment plans were changed for 18 of 65 patients (27.7%). The changes were avoiding unnecessary resection (7 benign SETs ≥3 cm in diameter), scheduling for definitive treatment (6 GI stromal tumors and 1 carcinoid tumor), and modifying the surgical field (3 large GI stromal tumors and 1 carcinoma). When we assessed treatment plans relative to tumor location, we found that avoiding unnecessary resection was associated with the presence of cardiac SETs.
    Limitations
    Retrospective study with a small number of patients.
    Conclusions
    EUS-TCB changed or influenced management decisions in 18 of 65 patients (27.7%) with gastric SETs. Patients could receive proper and tailored surgery, medical treatment, or surveillance according to size and location of SETs with EUS-TCB.
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