内镜超声引导下细针抽吸术确诊胰腺内副脾1例（含视频）

胰腺占位可由多种病因引起,包括胰腺导管腺癌、腺泡细胞癌等。本文报道了1例罕见的胰腺内占位,最终通过内镜超声引导下细针抽吸术（endoscopic ultrasound?guided fine?needle aspiration, EUS?FNA）联合免疫组化确诊为胰腺内副脾。     

内镜超声引导下细针抽吸活检术临床应用进展

内镜超声引导下细针抽吸活检术是在内镜超声的引导下对消化道及其周围脏器、组织病变进行细针穿刺，获取细胞学或组织学标本的一种活检方法。该文将从技术方法、适应证、临床应用及并发症等方面对该技术的研究进展情况进行综述。     

内镜超声引导下穿刺活检术在胰腺囊性病变中的 诊断价值

胰腺囊性病变同时包含良性和恶性,性质不同,预后截然不同。内镜超声引导下细针活检术(endoscopic ultrasound-guided fine needle biopsy,EUS-FNB)因其能够直接获取目标病变的囊液、细胞或组织辅助诊断而倍受青睐。本文对EUS-FNB在胰腺囊性病变诊断中的应用做一综述,大部分研究结果认为EUS-FNB获取病变组织标本进行诊断的能力优于内镜超声引导下细针抽吸术,而新近出现的内镜超声引导下小活检钳活检术亦被证实在病变组织标本及诊断价值方面有其独特的优势。     

胰腺实性占位超声内镜引导细针穿刺抽吸/活检术中内镜医师快速病理评估价值的研究进展

为提高超声内镜引导细针穿刺抽吸/活检术（endoscopic ultrasound‑guided fine‑needle aspiration/biopsy,EUS‑FNA/B）诊断准确率,快速现场评估（rapid on site evaluation,ROSE）被应用于该操作中,通过细胞病理医师现场评估标本取材满意度及标本的良恶性,让内镜医师及时获得反馈,以提高诊断准确率、减少不必要的穿刺。由于许多内镜中心无法实现细胞病理医师进行ROSE,目前逐渐出现内镜医师进行ROSE。内镜医师能否胜任ROSE,其诊断效能能否与细胞病理医师相媲美值得探讨。文中结合近年来文献进展,对内镜医师在胰腺实性占位EUS‑FNA/B标本快速评估中的作用进行了综述。     

内镜超声引导下胰腺细针穿刺术的研究进展

内镜超声引导下细针穿刺抽吸术和细针穿刺活检术可以在超声内镜实时引导下获取细胞学和（或）组织学标 本,其安全性和准确性已得到多篇研究证实,目前已成为获取胰腺病理诊断的一线操作技术。近年来,随着内镜超声 引导下胰腺细针穿刺手术的广泛普及,其相关研究也呈“井喷”趋势,为胰腺疾病的诊治开创了新局面、新发展。文章 拟就近年来内镜超声引导下胰腺细针穿刺的研究进展及其临床应用价值、发展方向做一评述。     

内镜超声引导下细针抽吸活检术临床应用进展

内镜超声引导下细针抽吸活检术是在内镜超声的引导下对消化道及其周围脏器、组织病变进行细针穿刺,获取细胞学或组织学标本的一种活检方法。该文将从技术方法、适应证、临床应用及并发症等方面对该技术的研究进展情况进行综述。     

超声内镜引导下细针穿刺抽吸/活检术在胰腺癌精准治疗中应用

胰腺癌发病率高,早期诊断率低,生存率低,预后差,严重威胁着居民的生活质量,且增加居民和国家的经济负担。超声内镜引导下细针抽吸/活检获取胰腺组织不仅可以用于胰腺癌的诊断,还可以联合基因突变检测、药物敏感性测定及异种移植、类器官构建从而指导胰腺癌的精准治疗;对于不可切除胰腺癌,基于超声内镜引导下细针穿刺介入治疗可以显著缓解患者疼痛症状,改善患者预后。     

内镜超声引导下细针抽吸术诊断脾脏病变系列报道（含视频）

脾脏肿瘤并不多见,但随着现代影像学技术的发展,越来越多的脾脏占位在体检时被偶然发现,而脾脏是人体的“血库”,活检出血风险极大,因此选择安全的技术获得脾脏样本尤为重要。本文报道了3例内镜超声引导下细针抽吸术（endoscopic ultrasoud-guided fine needle aspiration,EUS-FN...     

内镜超声引导下细针抽吸术对胰腺合并肝脏占位的诊断价值

2020年2—5月间,首都医科大学附属北京友谊医院消化内科对5例胰腺占位合并肝脏占位患者进行了内镜超声引导下细针抽吸术检查。胰腺占位3例位于胰头、1例位于胰颈、1例位于胰体,最大径3.2~4.6 cm,经2~4针穿刺,5例胰腺穿刺组织学和细胞学均为阳性。肝脏占位3例为肝左叶单发占位、1例为肝左叶多发占位、1例为肝左叶和肝右叶多发占位,最大径0.4~1.2 cm,经1~3针穿刺,4例患者肝脏穿刺细胞学和（或）组织学结果为阳性,余1例穿刺物涂片细胞学结果为阴性。5例术后均未出现腹痛、发热、出血、穿孔、感染、胰漏、高淀粉酶血症等并发症。由此可见,内镜超声引导下细针抽吸术对胰腺占位合并肝脏占位同时进行穿刺诊断是安全和有效的。     

内镜超声引导下细针抽吸术对内镜活检阴性消化道恶性狭窄的诊断价值（含视频）

评价内镜超声引导下细针抽吸术（endoscopic ultrasound-guided fine needle aspiration,EUS-FNA）对内镜活检阴性的消化道恶性狭窄的诊断价值及安全性。回顾性分析2016年7月—2020年1月于苏州大学附属第二医院行CT检查提示消化道恶性肿瘤伴管腔完全狭窄、内镜活检阴性行...     

Ultrasound-guided vs endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer diagnosis

AIM: To clarify the effectiveness and safety of endo- scopic ultrasound-guided fine-needle aspiration (EUS-FNA) for the diagnosis of pancreatic cancer (PC). METHODS: Patients who were diagnosed with unresectable, locally advanced or metastatic PC between February 2006 and September 2011 were selected for this retrospective study. FNA biopsy for pancreatic tumors had been performed percutaneously under extracorporeal ultrasound guidance until October 2009; then, beginning in November 2009, EUS-FNA has been performed. We reviewed the complete medical records of all patients who met the selection criteria for the following data: sex, age, location and size of the targeted tumor, histological and/or cytological findings, details of puncture procedures, time from day of puncture until day of definitive diagnosis, and details of severe adverse events. RESULTS: Of the 121 patients who met the selection criteria, 46 had a percutaneous biopsy (Group A) and 75 had an EUS-FNA biopsy (Group B). Adequate cytological specimens were obtained in 42 Group A patients (91.3%) and all 75 Group B patients (P=0.0192), and histological specimens were obtained in 41 Group A patients (89.1%) and 65 Group B patients (86.7%). Diagnosis of malignancy by cytology was positive in 33 Group A patients (78.6%) and 72 Group B patients (94.6%) (P=0.0079). Malignancy by both cytology and pathology was found in 43 Group A (93.5%) and 73 Group B (97.3%) patients. The mean period from the puncture until the cytological diagnosis in Group B was 1.7 d, which was significantly shorter than that in Group A (4.1 d) (P < 0.0001). Severe adverse events were experienced in two Group A patients (4.3%) and in one Group B patient (1.3%). CONCLUSION: EUS-FNA, as well as percutaneous needle aspiration, is an effective modality to obtain cytopathological confirmation in patients with advanced PC.     

Analysis of circulating cell-free DNA after endoscopic ultrasound-guided fine needle aspiration in pancreatic ductal adenocarcinoma

Background/ObjectivesRecently, increase in cell-free DNA (cfDNA) concentration or newly detected KRAS mutation after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy were reported to be related to the occurrence of new distant metastasis. In this study, we investigated whether cfDNA concentration increased with the release of tumor components into the blood after EUS-FNA and whether its increase was related to prognosis.MethodsSixty-eight patients underwent EUS-FNA and were pathologically confirmed as having pancreatic ductal adenocarcinoma (PDAC). We measured plasma cfDNA concentration and the copy number of KRAS mutation in 68 patients and circulating tumor cells in 8 before and after EUS-FNA.ResultsThe average cfDNA concentration after EUS-FNA (672.5 ± 919.6 ng/mL) was significantly higher than that before EUS-FNA (527.7 ± 827.3 ng/mL) (P < 0.001). KRAS mutation in plasma was detected in 8 patients (11.8%), however a significant increase in cfDNA concentration after EUS-FNA was not related to the change in KRAS-mutant copy number. Minimal increase in circulating tumor cells was observed in 3 of 8 patients. New distant metastasis was observed within 286 days to initial metastasis detection in 6 of 12 patients with ≥2-fold increase in cfDNA concentration and 26 of 56 patients with <2-fold increase within 185 days. In 32 patients who underwent surgery, ≥2-fold increase in cfDNA did not affect early recurrence.ConclusionsThe increase in cfDNA concentration after EUS-FNA was not caused by tumor cell components released into blood vessels. Hence, the risk of seeding via the blood stream after EUS-FNA may need not be considered.     

Push vs pull method for endoscopic ultrasound-guided fine needle aspiration of pancreatic head lesions: Propensity score matching analysis

AIM To evaluate the efficacy of endoscopic ultrasoundguided fine needle aspiration(EUS-FNA) of pancreatic head cancer when pushing(push method) or pulling the echoendoscope(pull method).METHODS Overall, 566 pancreatic cancer patients had their first EUS-FNA between February 2001 and December 2017. Among them, 201 who underwent EUS-FNA for pancreatic head lesions were included in this study. EUS-FNA was performed by the push method in 85 patients, the pull method in 101 patients and both the push and pull methods in 15 patients. After propensity score matching(age, sex, tumor diameter, and FNA needle), 85 patients each were stratified into the push and pull groups. Patient characteristics and EUSFNA-related factors were compared between the two groups.RESULTS Patient characteristics were not significantly different between the two groups. The distance to lesion was significantly longer in the push group than in the pull group(13.9 ± 4.9 mm vs 7.0 ± 4.9 mm, P 0.01). The push method was a significant factor influencing the distance to lesion(≥ median 10 mm)(P 0.01). Additionally, tumor diameter ≥ 25 mm(OR = 1.91, 95%CI: 1.02-3.58, P = 0.043) and the push method(OR = 1.91, 95%CI: 1.03-3.55, P = 0.04) were significant factors contributing to the histological diagnosis of malignancy.CONCLUSION The pull method shortened the distance between the endoscope and the lesion and facilitated EUS-FNA of pancreatic head cancer. The push method contributed to the histological diagnosis of pancreatic head cancer using EUS-FNA specimens.     

超声内镜引导细针穿刺抽吸术在常规内镜活检诊断不明确 的胃肠道病变中的应用价值

目的 评价超声内镜引导细针穿刺抽吸术（EUS-FNA）在常规内镜活检诊断不明确的胃肠道病变中的应用价值。 方法 回顾性分析65例常规内镜活检诊断不明确的胃肠道病变且在我院行EUS-FNA的患者的诊断结果和随访情况,以手术病理和随访结果为最终诊断,评估EUS-FNA对此类病变的诊断价值。结果 本研究中男性患者41例,女性24例,中位年龄60岁。普通内镜下以弥漫浸润型病变最为多见（56.9%）,其次为黏膜下隆起型病变（21.7%）。54例（83.1%）患者诊断为肿瘤性病变,非肿瘤性病变11例（83.1%）。EUS-FNA总的诊断敏感度、特异度及准确性为76.8%（95%CI: 65.7%-87.8%）、100%（95%CI: 66.4%-100%）、及80.0%（95%CI: 70.3%-89.7%）。亚组分析显示EUS-FNA在弥漫浸润型病变中的诊断敏感度、特异度及准确性分别为70.6%（95%CI: 55.3%-85.9%）、100%（95%CI: 29.2%-100%）及73.0%（95%CI: 58.7%-87.3%）;在黏膜下隆起型病变中的诊断敏感度、特异度及准确性分别为68.8%（95%CI: 46.0%-91.5%）、100%（95%CI: 2.5%-100%）及70.6%（95%CI: 44.0%-89.7%）。结论 EUS-FNA对常规内镜活检诊断不明确的胃肠道病变具有中等强度的诊断价值,可作为此类病变在常规内镜活检无法确诊后的备选方案,但仍需结合其他手段或技术改进以进一步提高EUS-FNA的诊断效能。     

Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses

AIM To evaluate the diagnostic accuracy of histological evaluation of pancreatic tissue samples obtained by a modified method for recovering and processing the endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) material in the differential diagnosis of pancreatic solid masses.METHODS Sixty-two consecutive patients with pancreatic masses were prospectively studied. EUS was performed by the linear scanning Pentax FG-38UX echoendoscope. Three FNAs (22G needle) were carried out during each procedure. The materials obtained with first and second punctures were processed for cytological study. Materials of the third puncture were recovered into 10% formol solution by careful injection of saline solution through the needle, and processed for histological study.RESULTS Length of the core specimen obtained for histological analysis was 6.5 5.3 mm (range 1-22 mm).Cytological and histological samples were considered as adequate in 51 (82.3%) and 52 cases (83.9%), respectively. Overall sensitivity of both pancreatic cytology and histology for diagnosis of malignancy was 68.4%. Contrary to cytology, histology was able to diagnose tumours other than adenocarcinomas, and all cases of inflammatory masses. Combination of cytology and histology allowed obtaining an adequate sample in 56 cases (90.3%),with a global sensitivity of 84.21%, specificity of 100%and an overall accuracy of 90.32%. The complication rate was 1.6%.CONCLUSION Adequate pancreatic core specimens for histological examination can be obtained by EUS-guided FNA. This technique is mainly useful for the diagnosis of different types of pancreatic tumours and evaluation of benign diseases.     

内镜超声及其引导下的细针穿刺活检在胰腺疾病中的诊断价值

目的:探讨内镜超声(EUS)及其引导下的细针穿刺活检(EUS-FNA)在胰腺疾病诊断中的价值.方法:回顾性分析2008-03/2010-03经EUS检查的62例胰腺疾病,其中有32例行细针穿刺活检.结果:(1)62例胰腺疾病中胰腺癌26例、慢性胰腺炎20例、胰腺囊肿10例、胰岛细胞瘤2例;(2)B超、CT、EUS/EU...     

Peritoneal dissemination of pancreatic cancer caused by endoscopic ultrasound-guided fine needle aspiration: A case report and literature review

BACKGROUND Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)is a biopsy technique widely used to diagnose pancreatic tumors because of its high sensitivity and specificity.Although needle-tract seeding caused by EUS-FNA has been recently reported,dissemination of pancreatic cancer cells is generally considered to be a rare complication that does not affect patient prognosis.However,the frequency of dissemination and needle-tract seeding appears to have been underestimated.We present a case of peritoneal dissemination of pancreatic cancer due to preoperative EUS-FNA.CASE SUMMARY An 81-year-old man was referred to the Department of Surgery of our hospital in Japan owing to the detection of a pancreatic mass on computed tomography during medical screening.Trans-gastric EUS-FNA revealed that the mass was an adenocarcinoma;hence laparoscopic distal pancreatectomy with lymphadenectomy was performed.No intraoperative peritoneal dissemination and liver metastasis were visually detected,and pelvic lavage cytology was negative for carcinoma cells.The postoperative surgical specimen was negative for carcinoma cells at the dissected margin and the cut end margin;however,pathological findings revealed adenocarcinoma cells on the peritoneal surface proximal to the needle puncture site,and the cells were suspected to be disseminated via EUSFNA.Hence,the patient received adjuvant therapy with S-1(tegafur,gimeracil,and oteracil potassium);however,computed tomography performed 5 mo after surgery revealed liver metastasis and cancerous peritonitis.The patient received palliative therapy and died 8 mo after the operation.CONCLUSION The indications of EUS-FNA should be carefully considered to avoid iatrogenic dissemination,especially for cancers in the pancreatic body or tail.     

Yield of endoscopic ultrasound-guided fine needle aspiration and endoscopic retrograde cholangiopancreatography for solid pancreatic neoplasms

Objective: Both endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) cytology may provide tissue diagnoses in solid pancreatic neoplasms. However, there are scant data comparing these two methods. This study aims at retrospectively comparing EUS-FNA and ERCP tissue sampling and ability of cytopathological diagnosis in solid pancreatic neoplasms and to determine usefulness and adverse events of combining both procedures. Material and methods: Two hundred and thirty four patients suspected to have solid pancreatic mass on abdominal ultrasound and/or computed tomography (CT) were enrolled. EUS-FNA (group A), ERCP cytology (group B) and combined procedures (Group C) performed in 105, 91 and 38 cases, respectively. Results: Sensitivity, specificity and accuracy were 98.9%, 93.3% and 98.1% for group A, and 72.1%, 60% and 71.4% for group B. Those for group C were all 100%. Sensitivity for malignancy in the pancreas head was 100% for group A and 82.4% for group B, and in the pancreas body and tail, 97.6% for group A and 57.1% for group B. EUS-FNA was more sensitive than ERCP cytology in diagnosing malignant pancreatic neoplasms 21–30?mm in size (p?=?0.0068), 31–40?mm (p?=?0.028) and?≥41?mm (p?Conclusions: EUS-FNA is superior to ERCP cytology for diagnosis of solid pancreatic neoplasms. Although combination of both procedures provide efficient tissue diagnosis and with a minimal adverse events rate, a prospective study including larger number of patients is required.     

Endoscopic ultrasound fine needle aspiration vs fine needle biopsy for pancreatic masses,subepithelial lesions,and lymph nodes

Endoscopic ultrasound tissue acquisition, in the form of both fine needle aspiration (EUS-FNA) and fine needle biopsy (EUS-FNB), is utilized for pancreatic mass lesions, subepithelial lesions, and lymph node biopsy. Both procedures are safe and yield high diagnostic value. Despite its high diagnostic yield, EUS-FNA has potential limitations associated with cytological aspirations, including inability to determine histologic architecture, and a small quantitative sample for further immunohistochemical staining. EUS-FNB, with its larger core biopsy needle, was designed to overcome these potential limitations. However, it remains unclear which technique should be used and for which lesions. Comparative trials are plagued by heterogeneity at every stage of comparison; including variable needles used, and different definitions of endpoints, which therefore limit generalizability. Thus, we present a review of prospective trials, systematic reviews, and meta-analyses on studies examining EUS-FNA vs EUS-FNB. Prospective comparative trials of EUS-FNA vs EUS-FNB primarily focus on pancreatic mass lesions, and yield conflicting results in terms of demonstrating the superiority of one method. However, consistent among trials is the potential for diagnosis with fewer passes, and a larger quantity of sample achieved for next generation sequencing. With regard to subepithelial lesions and lymph node biopsy, fewer prospective trials exist, and larger prospective studies are necessary. Based on the available literature, we would recommend EUS-FNB for peri-hepatic lymph nodes.