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。     

超声内镜引导细针穿刺抽吸/活检术诊断胆囊癌的研究进展

胆囊癌侵袭性强,进展速度快,早期诊断胆囊癌是提升预后的关键。本综述回顾了以胆囊为靶点的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）诊断胆囊癌的研究,总结了EUS‑FNA/B对胆囊癌的诊断效能、可能影响诊断率的因素以及不良事件。     

内镜超声引导下细针抽吸术联合流式细胞术在深部淋巴瘤诊断中的应用初探

目的探讨内镜超声引导下细针抽吸术（EUS—FNA）联合流式细胞术（FCM）在诊断腹膜后及纵隔等深部位淋巴瘤诊断中的应用价值。方法回顾性分析24例经B超、CT或MRI检查发现腹膜后或纵隔肿大淋巴结疑似淋巴瘤患者的病例资料,总结EUS—FNA联合FCM以及EUS—FNA联合普通细胞学病理学的检测结果,结合最终诊断结果统计上述两种检测方法的诊断性并行对比分析。结果24例中最终8例确诊为淋巴瘤,14例确诊为非淋巴瘤病变,2例无法明确诊断。EUS．FNA联合FCM诊断淋巴瘤的敏感度为87．5％（7／8）,特异度为100。0％（14／14）,阳性预测值为100．0％（7／7）,阴性预测值为93．3％（14／15）,准确率为95．5％（21／22）;EUS—FNA联合普通细胞学及病理学诊断淋巴瘤的敏感度为25．0％（2／8）,特异度为85．7％（12／14）,阳性预测值为50．0％（2／4）,阴性预测值为66．7％（12／18）,准确率为63．6％（14／22）。两种检测方法比较差异有统计学意义（P〈0．05）。结论EUS—FNA联合FCM是一种可靠的诊断非霍奇金淋巴瘤的手段,尤其是对以深部淋巴结肿大为主要表现的疑似淋巴瘤更应优先考虑行EUA—FNA联合FCM检测。     

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。     

超声内镜引导下细针抽吸术中辅助弹性成像的诊断价值

目的　探讨超声内镜弹性成像（endoscopic ultrasound elastography,EUS?E）辅助超声内镜引导下细针抽吸术（endoscopic ultrasound?guided fine needle aspiration,EUS?FNA）诊断上消化道周围恶性占位性病变的应用价值。方法　回顾性分析2020年1月—2021年4月在宁夏医科大学总医院成功完成EUS?FNA的54例患者（57个病灶）的临床资料,依据完成FNA时是否辅助使用EUS?E分为EUS?E组和非EUS?E组,其中2020年5月—2021年2月完成FNA的30例患者（31个病灶）在行FNA时均辅助使用EUS?E,为EUS?E组,其余24例患者（26个病灶）在行FNA时未辅助使用EUS?E,进行常规EUS?FNA,为非EUS?E组。评估EUS?FNA诊断效能,比较EUS?E组和非EUS?E组的诊断效能。分析EUS?E组中患者的EUS?E评分。结果　EUS?FNA诊断消化道周围恶性占位性病变的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为80.5% （33/41）、100.0%（16/16）、100.0%（33/33）、66.7%（16/24）和86.0%（49/57）。EUS?FNA在胰腺和其他部位（纵隔和腹腔）恶性占位性病变诊断中的敏感度［78.6%（22/28）比84.6%（11/13）,P=0.232］和准确率［83.8%（31/37）比90.0%（18/20）,P=0.156］比较差异无统计学意义。术后1例（1.85%,1/54）患者出现并发症。EUS?E组中EUS?FNA诊断消化道周围恶性占位性病变的敏感度［84.0%（21/25）比81.3%（13/16）,P=0.186］和准确率［87.1%（27/31）比88.5%（23/26）,P=0.186］与非EUS?E组相比差异无统计学意义。EUS?E组EUS?E评分≥3分预测恶性占位与最终诊断一致性较强（Kappa=0.63）。结论　EUS?FNA是一项安全有效的细胞组织病理诊断手段,在诊断上消化道周围占位性病变中起重要作用。EUS?E评分能很好地预测占位病变良恶性,但EUS弹性靶向FNA在诊断敏感度和准确率上未表现出优势。     

内镜超声引导下细针抽吸标本Dickkopf-1检测对胰腺癌的诊断价值

背景：Dickkopf-1（DKK-1）是一种分泌性蛋白,作为Wnt信号通路拮抗剂,在肿瘤的发生、发展过程中起重要作用。目的：检测胰腺内镜超声引导下细针抽吸（EUS—FNA）标本中的DKK-1表达情况,评价其对胰腺癌的诊断价值。方法：收集31例胰腺占位性病变患者的EUS—FNA标本,以免疫组化方法检测DKK-1蛋白表达,并与细胞学、组织学检查和最终诊断结果进行比较．结果：31例患者中24例最终诊断为胰腺癌,7例最终诊断为良性病变。胰腺癌EUS-FNA标本中DKK-1蛋白表达阳性率为70．8％．良性病变则不表达DKK-1蛋白．组间差异有统计学意义（P〈0．05）。EUS-FNA标本细胞学和组织学诊断胰腺癌的敏感性分别为583％和37．5％．特异性均为85．7％．两者如与DKK-1检测联合,敏感性和特异性分别提高至87．5％和100％。结论：胰腺EUS-FNA标本细胞学、组织学检查与DKK-1检测联合有助于提高胰腺癌的诊断水平．     

Comparative study of diagnostic value of cytologic sampling by endoscopic ultrasonography-guided fine-needle aspiration and that by endoscopic retrograde pancreatography for the management of pancreatic mass without biliary stricture

BACKGROUND: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) can now provide a cytopathological diagnosis of underlying pancreatic malignancy with higher success rates than endoscopic retrograde pancreatography (ERP). To determine the significance of EUS-FNA for the diagnosis of pancreatic mass without biliary stricture, the value of cytopathological diagnosis obtained by EUS-FNA was retrospectively compared with that by ERP, and the complications associated with these procedures evaluated. METHODS: Eighty-three patients who were suspected to have a pancreatic mass (excluding a cystic mass), without biliary stricture on conventional ultrasound and/or computed tomography were enrolled. The EUS-FNA biopsy was performed in 53 patients and cytology utilizing ERP was performed in 30 patients. RESULTS: The sampling rate of adequate specimen was 100% in both groups. In the EUS-FNA group, the overall results for the available samples were sensitivity 92.9% and accuracy 94.3%. In contrast, in the ERCP group, the overall results were sensitivity 33.3% and accuracy 46.7%. There was a significant difference between the two groups (P < 0.01). With regard to complications, there was a significant difference (P < 0.01) in the frequency of post-procedure pancreatitis between the EUS-FNA group and ERP group (0%, 0/53 vs 33.3%, 10/30, respectively). CONCLUSION: Endoscopic ultrasonography-guided fine-needle aspiration is safer and more accurate for the cytopathological diagnosis of suspected pancreatic masses without a biliary stricture as compared with cytology during ERP. Endoscopic ultrasonography with FNA should be considered a preferred test (prior to attempting endoscopic retrograde cholangiopancreatography) when a cytological diagnosis of a pancreatic mass is required, especially when there is no biliary obstruction, or when emergent decompression of an obstructed biliary tree is not considered clinically necessary due to lack of signs and symptoms of cholangitis.     

Histological diagnosis of gastric submucosal tumors: A pilot study of endoscopic ultrasonography-guided fine-needle aspiration biopsy vs mucosal cutting biopsy

AIM: To compare the usefulness of endoscopic ultrasonography-guided fine-needle aspiration biopsy(EUS-FNAB) without cytology and mucosal cutting biopsy(MCB) in the histological diagnosis of gastric submucosal tumor(SMT).METHODS: We prospectively compared the diagnostic yield, feasibility, and safety of EUS-FNAB and those of MCB based on endoscopic submucosal dissection. The cases of 20 consecutive patients with gastric SMT ≥1 cm in diameter. who underwent both EUS-FNAB and MCB were investigated.RESULTS: The histological diagnoses were gastrointestinal stromal tumors(n = 7), leiomyoma(n =6), schwannoma(n = 2), aberrant pancreas(n = 2), and one case each of glomus tumor, metastatic hepatocellular carcinoma, and no-diagnosis. The tumors' mean size was 23.6 mm. Histological diagnosis was made in 65.0% of the EUS-FNABs and 60.0% of the MCBs, a nonsignificant difference. There were no significant differences in the diagnostic yield concerning the tumor location or tumor size between the two methods. However, diagnostic specimens were significantly more frequently obtained in lesions with intraluminal growth than in those with extraluminal growth by the MCB method(P = 0.01). All four SMTs with extraluminal growth were diagnosed only by EUSFNAB(P = 0.03). No complications were found in either method.CONCLUSION: MCB may be chosen as an alternative diagnostic modality in tumors showing the intraluminal growth pattern regardless of tumor size, whereas EUSFNAB should be performed for SMTs with extraluminal growth.     

Age and cystic size are associated with clinical impact of endoscopic ultrasonography-guided fine-needle aspiration on the management of pancreatic cystic neoplasms

Objectives: The clinical impact of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) in managing pancreatic cystic neoplasms (PCNs) remains controversial. The aim of this study was to identify which patients with PCNs would benefit from EUS-FNA.

Methods: A retrospective study was performed on patients with PCNs who underwent EUS-FNA between January 2009 and June 2018. A discordant or a consistent diagnosis after EUS-FNA was analyzed and was correlated with the clinical demographic data and cystic features. Predictors of the change in the diagnosis after EUS-FNA were analyzed.

Results: One hundred eighty-eight cases of PCNs were analyzed. EUS-FNA changed the diagnosis in 45.7% of all patients with PCNs and 54.5% patients with presumed branch ductal type intraductal papillary mucinous neoplasm (BD-IPMN) and impacted the recommendation in 35.6% of patients with PCNs and 50.5% patients with BD-IPMN. Patients with a discordant diagnosis after EUS-FNA were younger in age (54.8?±?12.6 vs. 61.2?±?14.2; p=.037) and had a cyst size larger than 3?cm than patients with a consistent diagnosis after EUS-FNA. The only worrisome feature (WF) that differed between patients with a discordant and a consistent diagnosis after EUS-FNA was the main pancreatic duct (MPD) between 5 and 9?mm (p=.013). In multivariate analysis, a cyst size >3?cm and age were independent predictors of diagnostic changes after EUS-FNA (OR: 5.33, 95% CI: 1.79–15.88, p?=?.003; OR: 0.96, 95% CI: 0.93–0.99, p = .031).

Conclusions: EUS-FNA made a significant change in the management of nearly half of the patients with PCNs, especially in younger patients and in patients with a cyst size larger than 3?cm.     

内镜超声引导下细针穿刺抽吸术对胰腺癌的诊断价值

目的探讨内镜超声引导下细针穿刺抽吸术（EUS-FNA）对胰腺占位性病变特别是胰腺癌的诊断价值。方法对2005年后经B超、CT、MRI等影像学诊断和（或）临床疑诊胰腺癌的37例患者,在EUS引导下对病变作细针穿刺抽吸活检（FNA）,对于囊实性病变同时抽取囊液化验淀粉酶及肿瘤标志物等指标。结果EUS-FNA检出胰腺导管细胞癌16例,转移性肾细胞癌1例,可疑癌5例,异型细胞6例,正常胰腺组织6例,非胰腺成分3例。随访至2008年7月时,已证实胰腺癌25例,良性10例（慢性胰腺炎4例,囊腺瘤4例,假性囊肿2例）,尚有2例无法确诊。EUS-FNA诊断胰腺癌的敏感性为80．0％（95％CI：59．0-93．0）,特异性为100．0％（95％CI：60．0—100．0）,阳性预测值为100．0％（95％CI：80．0-100．0）,阴性预测值为55．6％（95％CI：27．0-79．0）。6例病变获取囊液进行淀粉酶、肿瘤标志物分析。本组EUS-FNA术后无严重并发症发生。结论EUS-FNA是一项安全有效的操作,对于胰腺占位性病变尤其是胰腺癌的诊断具有重要的意义。     

Prospective comparative study of endoscopic ultrasonography-guided fine-needle biopsy and unroofing biopsy

Background and aimAdequate tissue acquisition is important in making treatment decisions for patients with upper gastrointestinal subepithelial tumors (SETs). This study aimed to compare the outcomes of endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) with those of the unroofing biopsy technique.MethodsThis study was a single-center, prospective comparative study conducted at Severance Hospital, Yonsei University College of Medicine. A total of 39 patients with SETs ≥15 mm were enrolled between January 2016 and August 2017.ResultsOf the 39 patients, 28 underwent biopsy with both techniques (4 underwent only unroofing and 7 underwent only EUS-FNB). Histological diagnosis was made with EUS-FNB in 64.3% and unroofing biopsy in 78.6% (p = 0.344), and immunohistochemical diagnosis was made with EUS-FNB in 46.4% and unroofing biopsy in 67.9% (p = 0.180). In the subgroup analysis (28 patients), there was no significant difference in diagnostic yield between the 2 methods The mean procedural time with EUS-FNB was shorter than that with unroofing biopsy (p < 0.001). The larger SET (≥ 20 mm) (p = 0.035) and satisfaction of procedure (p = 0.019) were positively associated with successful histological diagnosis by EUS-FNB.ConclusionsThere was no significant difference in the histological diagnostic yield for SETs between the EUS-FNB and unroofing biopsy techniques (CinicalTrials.gov. identifier NCT02646241).     

Diagnosis of solid pancreatic masses by endoscopic ultrasound-guided fine-needle aspiration

Background:  Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) is increasingly being used in the staging algorithm for pancreatic carcinoma. This allows for a tissue diagnosis, which was previously difficult to obtain. The aim of this study is to assess the utility of EUS–FNA in establishing the diagnosis of solid pancreatic mass lesions in an Australian population.
Methods:  A retrospective review of the EUS databases of St Vincent's Hospital Melbourne and Western Hospital, Melbourne from November 2002 to May 2006 was undertaken. The focus was on patients with a solid pancreatic mass who underwent EUS–FNA. Surgical pathology or long-term follow up was used to identify false-positive or false-negative results.
Results:  EUS was undertaken to investigate a solid pancreatic or distal common bile duct mass lesion in 155 patients. Seventy-two of these underwent EUS-guided FNA. Mean age was 68 years. A positive tissue diagnosis of malignancy could be made in 55 (76%). Nine (13%) had benign histology, with 8 (11%) having inadequate tissue obtained from FNA. A later tissue diagnosis of carcinoma was made in eight of those with either benign or inadequate histology, although in all cases there were EUS features diagnostic of malignancy, with FNA limited by technical difficulties. The overall utility of EUS–FNA showed a sensitivity of 87%, specificity 100%, positive predictive value 100%, negative predictive value 52% and overall accuracy 89%.
Conclusion:  EUS–FNA gives a high return for histological diagnosis of solid pancreatic mass lesions and should be part of the standard management algorithm for pancreatic carcinoma.     

Resected tumor seeding in stomach wall due to endoscopic ultrasonography-guided fine needle aspiration of pancreatic adenocarcinoma

Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is a useful and relatively safe tool for the diagnosis and staging of pancreatic cancer. However, there have recently been several reports of tumor seeding after EUS-FNA of adenocarcinomas. A 78-year-old man was admitted to our hospital due to upper gastric pain. Examinations revealed a 20 mm mass in the pancreatic body, for which EUS-FNA was performed. The cytology of the lesion was adenocarcinoma, and the stage of the cancer was T3N0M0. The patient underwent surgery with curative intent, followed by adjuvant chemotherapy with S-1. An enlarging gastric submucosal tumor was found on gastroscopy at 28 mo after surgery accompanied by a rising level of CA19-9. Biopsy result was adenocarcinoma, consistent with a pancreatic primary tumor. Tumor seeding after EUS-FNA was strongly suspected. The patient underwent surgical resection of the gastric tumor with curative intent. The pathological result of the resected gastric specimen was adenocarcinoma with a perfectly matched mucin special stain result with the previously resected pancreatic cancer. This is the first case report of tumor seeding after EUS-FNA which was surgically resected and inspected pathologically.     

超声内镜引导下细针穿刺病理诊断慢性胰腺炎的临床研究

目的为了获得病理组织学诊断慢性胰腺炎，根据临床表现、影像学和外分泌功能检查临床疑为慢性胰腺炎的47例患者，采用超声内镜引导下对胰腺行细针穿刺取得组织而进行病理学诊断。方法47例患者，男28例、女19例，年龄47～69岁，平均52．3岁，病程在3～21年之间，平均6．3年，临床疑为慢性胰腺炎、胰腺占位病变，并进行了相应的N-苯甲酰-L酪氨酰对氨苯甲酸(BT—PABA)试验、大便苏丹Ⅲ染色及胰腺CT检查的患者行超声内镜引导下细针穿刺(EUS-FNA)，取得组织，进行病理学诊断。结果47例患者中，EUS-FNA的病理组织学诊断慢性胰腺炎为31例(31／47、69％)。结论通过EUS-FNA进行病理学诊断，解决了以往慢性胰腺炎只有临床诊断没有病理诊断难题，从而为临床提供了诊断慢性胰腺炎的有效方法。