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基于国际共识诊断标准用22号细针行超声内镜引导下的细针穿刺术诊断自身免疫性胰腺炎

发布日期:2014-1-29 12:40:53 文章来源:ENDOSCOPY 作者次数:1466
    基于国际共识诊断标准用22号细针行超声内镜引导下的细针穿刺术诊断自身免疫性胰腺炎

    背景

    22号(G)细针行超声内镜引导下的细针穿刺是否对自身免疫性胰腺炎(AIP)的诊断和评估有用,目前人们对这个问题存在争议。

    目的

    评估采用22G细针行超声内镜引导下的细针穿刺对病理组织学诊断自身免疫性胰腺炎的实用性。

    设计

    一项回顾性研究。

    实验环境

    单学术中心。

    患者

    273例患者,包括25例自身免疫性胰腺炎患者,他们接受了超声内镜引导下的细针穿刺术和组织学检查。

    结果

    采用22 G细针行超声内镜引导下的细针穿刺为组织病理学评估提供了充足的组织样本,因为在25例患者中,有20例患者有10个高倍视野可用于评估(80%)。平均免疫球蛋白G4阳性浆细胞计数为每高倍视野13.7个。25例患者中有10例出现闭塞性静脉炎(40%)。在AIP国际共识诊断标准的背景下,25例患者中分别有14例和6例被判定为1级(34项为阳性)和2级(2项为阳性)病理诊断结果,这意味着根据国际共识诊断标准,25例患者中有20例被建议患有淋巴浆细胞硬化性胰腺炎。1例患者被诊断为2型自身免疫性胰腺炎,因为我们发现该患者有粒细胞上皮病变。

    局限性

    患者数量较少的回顾性研究。

    结论

    本研究结果表明,采用22 G 细针行超声内镜引导下的细针穿刺可为组织病理学评估提供足够的组织样本,并极大地有助于自身免疫性胰腺炎的组织学诊断。

    缩写词:AIP,自身免疫性胰腺炎;EUS-FNA,超声内镜引导下的细针穿刺术;EUS-TCB,超声内镜引导下的Tru-cut 活检;G,标准尺寸;GEL,粒细胞上皮病变;HPF,高倍视野;ICDC,国际共识的诊断标准;IDCP,特发性导管中央型慢性胰腺炎;IgG,免疫球蛋白GLPSP,淋巴浆细胞硬化性胰腺炎


     

    Diagnosis of autoimmune pancreatitis by EUS-FNA by using a 22-gauge needle based on the International Consensus Diagnostic Criteria

    Received 3 January 2012; accepted 9 May 2012.

    Background

    It is controversial whether EUS-guided FNA by using 22-gauge (G) needles is useful for the diagnosis or evaluation of autoimmune pancreatitis (AIP).

    Objective

    To evaluate the usefulness of EUS-FNA by 22-G needles for the histopathological diagnosis of AIP.

    Design

    A retrospective study.

    Setting

    Single academic center.

    Patients

    A total of 273 patients, including 25 with AIP, underwent EUS-FNA and histological examinations.

    Results

    EUS-FNA by using 22-G needles provided adequate tissue samples for histopathological evaluation because more than 10 high-power fields were available for evaluation in 20 of 25 patients (80%). The mean immunoglobulin G4–positive plasma cell count was 13.7/high-power field. Obliterative phlebitis was observed in 10 of 25 patients (40%). In the context of the International Consensus Diagnostic Criteria for AIP, 14 and 6 of 25 patients were judged to have level 1 (positive for 3 or 4 items) and level 2 (positive for 2 items) histological findings, respectively, meaning that 20 of 25 patients were suggested to have lymphoplasmacytic sclerosing pancreatitis based on the International Consensus Diagnostic Criteria. The diagnosis in 1 patient was type 2 AIP because a granulocytic epithelial lesion was identified in this patient.

    Limitations

    A retrospective study with a small number of patients.

    Conclusions

    The results of this study suggest that EUS-FNA by using 22-G needles provides tissue samples adequate for histopathological evaluation and greatly contributes to the histological diagnosis of AIP.

    Abbreviations:  AIP, autoimmune pancreatitis, EUS-FNA, EUS-guided FNA, EUS-TCB, EUS-guided Tru-cut biopsy, G, gauge, GEL, granulocytic epithelial lesion, HPF, high-power field, ICDC, International Consensus Diagnostic Criteria, IDCP, idiopathic duct-centric chronic pancreatitis, IgG, immunoglobulin G, LPSP, lymphoplasmacytic sclerosing pancreatitis

     

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