内镜超声引导下细针穿刺抽吸术对胰腺占位病变诊断价值及其影响因素的研究

目的探讨内镜超声引导下细针穿刺抽吸术（EUS—FNA）对胰腺占位病变的诊断价值及影响其准确率的相关因素。方法回顾性统计101例因胰腺占位病变行EUS—FNA患者的临床资料，纳入患者性别、年龄、病灶部位、大小、性状、穿刺时抽吸负压、穿刺次数、实时细胞学诊断、超声内镜类型、操作医师经验等10个因素进行分析。结果EUS-FNA总体诊断准确率为85．1％，敏感度为81．1％，特异度为96．3％，阳性预测值为98．4％，阴性预测值为65．0％。单因素Logistic回归分析示，EUS-FNA穿刺阳性率的相关影响因素有病灶大小、病灶性状、抽吸负压、操作医师经验（P〈0．05），EUS-FNA诊断准确率的相关影响因素只有病灶大小（OR=1．984，95％CI：1．141—3．451，P=0．015），病灶每增大1cm，其穿刺阳性的概率增加1．67倍，其穿刺诊断准确的概率增加1．83倍。多因素Logistic回归分析显示，EUS．FNA穿刺阳性率的独立影响因素有病灶大小（OR=2．012，95％CI：1．394—2．906，P=0．000）和病灶性状（OR=10．218，95％CI：2．432～42．937，P=0．002），实性病灶穿刺阳性的概率为囊性病灶的10．2倍；EUS—FNA诊断准确率的独立影响因素为病灶大小（OR=1．984，95％CI：1．141—3．451，P=0．015）。结论EUS．FNA是一项安全有效、特异度高的诊断手段，在胰腺占位病灶的病理诊断中具有重要临床价值。EUS-FNA穿刺阳性率及诊断准确率均与胰腺病灶大小呈显著正相关。胰腺实性病灶的穿刺阳性率显著高于囊性病灶。

Diagnostic value of EUS-FNA for pancreatic masses and its influential factors

Objective To investigate the diagnostic value of EUS-FNA for pancreatic masses and correlated influential factors. Methods We retrospectively analyzed the clinical data of 101 patients with pancreatic lesions who underwent EUS-FNA from January 2008 to January 2010. The clinical data enrolled 10 factors including patient gender, patient age, lesion location, lesion size, lesion characteristics, negative suction pressure, times of access, real-time cytological diagnosis, type of EUS and operators' experiences.Results The overall diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNA were 85. 1％, 81.1％, 96. 3％, 98. 4％ and 65.0％, respectively. Univariable logistic regression analysis indicated that lesion size, lesion characteristics, negative suction pressure, operators' experience were correlated factors of EUS-FNA positive rate, while lesion size was the only correlated factor of EUS-FNA diagnostic accuracy ( OR =1. 984,95 ％ CI: 1. 141 ～ 3. 451, P =0. 015 ). Every 1 cm the lesion increased, by 1.67 times of opportunity the positive rate became, by 1.83 times of opportunity the accuracy was. The lesion size and lesion characteristics were independent correlated factors of EUS-FNA positive rate (OR=2.012, P=0.000; OR =10.218, P=0. 002). The positive rate of EUS-FNA in solid lesions was 10. 2 times of that in cystic lesions. Lesion size was the independent correlated factors of EUS-FNA diagnostic accuracy (OR =1. 984, P =0. 015 ). Conclusion EUS-FNA can effectively make a pathological diagnosis of pancreatic masses with high diagnostic accuracy and specificity. EUS-FNA diagnostic positive rate and accuracy were both positively correlated with pancreatic lesion size. EUS-FNA positive rate of solid pancreatic lesions is significantly higher than that of cystic lesions.