超声内镜引导不同型号细针穿刺胰腺占位病灶的前瞻随机对照研究

目的 通过分析EUS-FNA获得的细胞量及细胞学诊断结果,比较3种不同型号穿刺针在胰腺实性占位诊断中的差异.方法 纳入2010年12月至2011年5月期间两家医院胰腺实质性占位病灶长轴直径大于2 cm并进行EUS-FNA的病例.根据穿刺途径将患者分为经胃壁穿刺组(19 G或22 G或25 G)和经十二指肠壁穿刺组(22 G或25 G),分别按事先设置的随机表随机选择穿刺针型号进行EUS-FNA.穿刺过程中,固定穿刺次数、吸引负压、穿刺针在病灶内移动次数和移动距离,穿刺内容物送液基细胞学检查,由同一位细胞学医生制片及诊断对EUS-FNA获得的细胞量及细胞学诊断结果进行比较.结果 研究共纳入病例52例,经胃壁穿刺组42例,经十二指肠壁穿刺组10例.所有病例均成功完成穿刺操作并未出现与EUS-FNA操作相关的并发症.两个穿刺组中不同型号穿刺针所获得的细胞总量、细胞学诊断之间的差异均无统计学意义(P＞0.05).但在两组中25 G穿刺针的诊断敏感度、特异度、阳性预测值、阴性预测值和准确率均稍高.结论 EUS-FNA在胰腺实质性占位中具有较高的诊断价值,尽管25 G穿刺针对胰腺病灶的诊断略显优势,但3种不同型号的穿刺针获得的细胞量及细胞学诊断并无显著差异.     

经培训内镜医师实施快速现场评估在内镜超声引导下细针抽吸术诊断胰腺实性占位中的价值

目的探讨经培训内镜医师实施快速现场评估（rapid on-site evaluation by endoscopic physicians themselves, self-ROSE）在胰腺实性占位内镜超声引导下细针抽吸术(endoscopic ultrasound-guided-fine needle aspiration, EUS-FNA)中的应用价值。方法回顾性分析2017年1—12月在南京鼓楼医院接受EUS-FNA的连续124例胰腺实性占位患者的临床资料。2017年7—12月的病例行self-ROSE，纳入self-ROSE组（60例）；2017年1月—2017年6月的病例未行self-ROSE，纳入非self-ROSE组（64例）。比较self-ROSE组与非self-ROSE组患者EUS-FNA的诊断效能（灵敏度、特异度、阳性预测值、阴性预测值和准确率）、穿刺次数及并发症发生率等指标。结果self-ROSE组的EUS-FNA诊断灵敏度、特异度、阳性预测值、阴性预测值、准确率分别为98.21%（55/56）、4/4、100.00%（55/55）、4/5和98.33%（59/60），而非self-ROSE组的EUS-FNA诊断灵敏度、特异度、阳性预测值、阴性预测值、准确率分别为81.82%（45/55）、9/9、100.00%（45/45）、47.37%（9/19）和84.38%（54/64）。self-ROSE组EUS-FNA的灵敏度（P=0.004）和准确率（P=0.009）均显著高于非self-ROSE组。在样本满意程度评估（Kappa＝1.000，P＜0.05）和细胞病理学评估（Kappa＝0.815，P＜0.05）方面，内镜医师与病理医师均呈现出高度的一致性。2组患者穿刺次数差异无统计学意义[（2.78±0.83）针比（2.61±0.75）针，P＞0.05]。2组均无并发症发生。结论self-ROSE有助于提升胰腺实性占位EUS-FNA的诊断效能，可作为提高EUS-FNA诊断准确率的重要策略。     

内镜超声引导下细针穿刺活检诊断上消化道壁外占位性病变的价值

目的 探讨内镜超声引导下细针穿刺活检(EUS-FNA)在上消化道壁外占位性病变(胰腺、纵隔、腹膜后占位)诊断中的应用价值.方法 回顾性总结行EUS-FNA检查的33例胰腺占位、25例纵隔占位和13例腹膜后占位患者的临床资料,以手术病理或6个月临床随访结果作为最终诊断,统计EUS-FNA对不同分类上消化道壁外恶性占位诊断的敏感度、特异度、阳性预测值、阴性预测值和准确率.结果 EUS-FNA诊断上消化道壁外恶性占位的总体敏感度、特异度、阳性预测值、阴性预测值、准确率分别为82.2％(37/45)、100.0％(26/26)、100.0％(37/37)、76.5％(26/34)、88.7％(63/71),且分别诊断胰腺、纵隔、腹膜后恶性占位的敏感度、特异度、阳性预测值、阴性预测值、准确率均较高.病灶直径＞3 cm恶性占位EUS-FNA诊断的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为81.0％(17/21)、100.0％(13/13)、100.0％(17/17)、76.5％(13/17)、88.2％(30/34),病灶直径≤3 cm恶性占位的诊断敏感度、特异度、阳性预测值、阴性预测值及准确率分别为83.3％(20/24)、100.0％(13/13)、100.0％ (20/20)、76.5％ (13/17)、89.2％(33/37),两者比较差异均无统计学意义(P＞0.05).71例患者均未出现出血、穿孔、胰腺炎、胰瘘及感染、胸痛、气胸等并发症.结论 EUS-FNA是一种安全、准确、有效地诊断上消化道壁外占位性病变的方法,且诊断准确率不受病灶大小的影响.     

超声内镜引导下细针穿刺在消化系占位性病变诊断中的价值

目的 探讨超声内镜引导下的细针穿刺检查(EUS-FNA)在消化系占位性病变诊断中的价值.方法 2007年5月-2008年12月对68例患者行超声内镜检查及超声内镜引导下的细针穿刺检查,对比细胞学和(或)病理学检查结果与术后病理结果及随访结果.结果 EUS-FNA细胞取材成功率91.18%(62/68).其中病灶位于食管4例(6.45%,4/62),胃19例(30.65%,19/62),直肠19例(30.65%,19/62),肝脏3例(4.84%,3/62),纵隔4例(6.45%,4/62),淋巴结13例(20.97%,13/62).40例患者细胞学检查结果阳性,阳性率为64.52%(40/62).22例患者获得组织碎片或细条行病理学检查,组织获得率为35.48%(22/62),其中10例病理学检查结果阳性,阳性率为45.45%(10/22).与术后病理结果及长期随访结果对照,EUS-FNA对消化系占位性病变诊断的准确率为85.48%.敏感度为90.91%,特异度为100.00%,阴性预测值为57.14%,阳性预测值为100.00%.结论 在消化系占位性病变诊断中,EUS-FNA是一项安全、有效、准确的诊断及鉴别诊断方法,在细胞学诊断中具有重要临床价值.     

超声内镜引导下细针穿刺联合肿瘤标志物对胰腺占位诊断价值及其影响因素

目的 探讨肿瘤标志物联合超声内镜引导下细针穿刺(endoscopic ultrasonography-guided fine needle aspiration, EUS-FNA)对胰腺占位的诊断价值,并分析其相关影响因素。方法 选取2021年8月至2022年8月于重庆医科大学附属第一医院确诊的68例胰腺占位患者,全部患者均完成EUS-FNA,分析患者的临床资料及病理结果。结果 68例患者中,EUS-FNA对胰腺占位诊断的准确率为94.12%、灵敏度为92.86%、特异度为100%;EUS-FNA穿刺阳性患者年龄>60岁、胰腺占位大小>2 cm、穿刺次数≥3次的比例高于穿刺阴性患者;恶性胰腺占位组CA19-9水平高于良性胰腺占位组;CA19-9对恶性胰腺占位诊断的准确率为75.00%、灵敏度为75.00%、特异度为75.00%;CA19-9联合EUS-FNA对恶性胰腺占位诊断的准确率为97.06%、灵敏度为96.43%、特异度为100%。结论 EUS-FNA诊断胰腺占位安全且准确率较高;EUS-FNA诊断胰腺占位的影响因素有穿刺次数、占位大小、年龄;EUS-FNA联合肿瘤标...     

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。     

内镜超声引导下细针抽吸术诊断消化道周围占位性病变的临床价值及影响因素研究

目的 探讨内镜超声引导下细针抽吸术（EUS-FNA）诊断消化道周围占位性病变的价值及其影响因素。 方法 回顾性分析2009年1月至2016年5月行EUS-FNA的171例患者的临床资料,纳入病灶部位、大小、性状,穿刺次数、穿刺时抽吸负压、穿刺针型号、医师操作经验等因素进行分析。 结果 EUS-FNA诊断消化道周围恶性占位性病变的敏感度、特异度和准确率分别为78.3％（83／106）、100.0％（65／65）、86.5％（148／171）。单因素logistic回归分析示,EUS-FNA诊断恶性占位性病变穿刺阳性率的影响因素有病灶部位、性状、大小。多因素logistic分析示,病灶大小（OR=1.029,95％CI：1.011～1.047,P=0.001）、病灶性状（实性及囊实性/囊性,OR=5.098,95％CI：1.324～19.633,P=0.018）是EUS-FNA诊断恶性占位性病变穿刺阳性率的独立影响因素。171例患者中,术后2例出现发热,1例出现急性胰腺炎,并发症发生率为1.75％（3／171）,经保守对症处理后均好转。 结论 EUS-FNA是一项安全有效、敏感度和准确率高的细胞组织病理诊断手段,在鉴别消化道周围良恶性占位性病变中起重要作用。EUS-FNA诊断恶性占位性病变穿刺阳性率与病灶大小呈正相关,诊断实性恶性占位性病变的穿刺阳性率显著高于囊性病变。     

EUS-FNA对消化系统占位性病变的诊断价值及影响因素

目的研究内镜超声引导下细针抽吸术(EUS-FNA)诊断消化系统占位性病变的诊断价值及其影响因素。方法回顾性分析两院120例消化系统病变患者临床资料,所有患者均接受EUS-FNA及活检病理检查,并经手术病理确诊。记录EUS-FNA与手术病理的一致性,比较EUS-FNA诊断的准确性,采用Logistic多因素分析法记录影像EUS-FNA诊断效能的独立影响因素。结果 EUS-FNA与手术病理检查对消化系统占位性病变的诊断结果具有满意的一致性(kappa=0. 883,P=0. 000)。EUS-FNA诊断消化系统恶性占位性病变的灵敏度为84. 62%、特异度为83. 82%、准确度为84. 62%。Logistic多因素分析结果显示病灶直径是影响EUS-FNA占位性病变诊断准确性的独立影响因素(OR=1. 724,95%CI=1. 335～2. 226,P=0. 000)。结论 EUS-FNA诊断消化系统占位性病变与手术病理结果的一致性高,但其准确性受病变直径影响,尤其是对于直径3 cm的微小病灶,应仔细探查,准确定位。     

不同肺活检方式在老年肺周围型肿块诊断中的价值

目的 研究不同肺活检方式在肺周围型肿块诊断中的价值及应用安全性。方法 选择2019年6月至2021年6月邯郸市第四医院收治的经影像学诊断为肺周围型病变的286例老年患者为研究对象,根据肺活检方式,将患者分为经皮肺穿刺活检(TNLB)组(n=165)与经支气管镜透壁肺活检(TBLB)组(n=121)。以病理检查及随访结果作为“金标准”,采用McNemar检验,计算TNLB、TBLB在诊断肺周围型肿块性质中的灵敏度、特异度、准确度、阳性预测值及阴性预测值。采用SPSS 19.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。结果 TNLB组165例患者中,阳性者51例,阴性者114例,阴性者中有9例经随访及手术病理检查证实为恶性病变。TNLB在诊断肺周围型肿块中的灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为：85.00%、100.00%、94.55%、100.00%和92.11%。TBLB组121例患者中,阳性者23例,阴性者98例,阴性者中有16例后经随访证实为恶性病变。TBLB在诊断肺周围型肿块中的灵敏度、特异度、准确度、阳性预测...     

超声内镜引导下细针穿刺活检对胰腺占位病变的诊断价值

[目的]通过超声内镜结合细针穿刺活检(EUS-FNA)确定胰腺占位病变的性质,并评价该法对胰腺病变的诊断价值。[方法]入选经影像学检查示胰腺占位病变患者113例,对占位病变行EUS-FNA检查,评价EUSFNA的敏感性、特异性、准确性、阳性预测值、阴性预测值。[结果]113例患者均获得组织学或细胞学标本,穿刺成功率为100.0%。EUS-FNA对于胰腺占位病变诊断的准确性、特异性、敏感性、阳性预测值、阴性预测值分别为:89.4%、100.0%、85.8%、100.0%、33.3%。所有患者均未发生严重并发症。[结论]EUS-FNA对诊断胰腺占位性病变安全、有效,具有重要临床意义。     

内镜超声引导下细针穿刺活检对占位性病变的诊断价值

背景：内镜超声引导下细针穿刺活检（EUS—FNA）广泛应用于占位性病变的诊断,但其诊断价值尚未完全明确。目的：评价EUS—FNA对占位性病变的诊断价值。方法：纳入2010年12月～2012年12月于华中科技大学同济医学院附属协和医院就诊的占位性病变患者70例,对占位性病变行EUS—FNA检查,以术后病理诊断作为金标准,评价EUS·FNA的阳性预测值、阴性预测值、敏感性、特异性、准确性以及约登指数。结果：66例患者获得足够细胞或组织学标本,穿刺成功率为94．3％。穿刺成功患者（66例）中,EUS—FNA的阳性预测值、阴性预测值、敏感性、特异性、准确性、约登指数分别为100％、36．4％、88．7％、100％、89．4％和0．887;所有穿刺患者（70例）中,上述数值分别为100％、26．7％、83．3％、100％、84．3％和0．833。所有患者均未发生严重并发症。结论：EUS—FNA对诊断占位性病变安全、有效,具有重要临床价值。     

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。     

Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis

BACKGROUND: Evaluation of a focal pancreatic mass in the setting of chronic pancreatitis (CP) is a diagnostic challenge. The objectives of the study were to compare the diagnostic yield and accuracy of EUS-guided FNA (EUS-FNA) in the evaluation of pancreatic-mass lesions in the presence or the absence of CP and to identify predictors of CP before EUS-FNA of pancreatic-mass lesions. METHODS: The study design was analysis of data collected prospectively on all patients with solid pancreatic-mass lesions who underwent EUS-FNA at a tertiary referral center. A total of 282 consecutive patients underwent 300 EUS-FNA procedures of pancreatic-mass lesions over a 3-year period. The diagnostic yield and the accuracy of EUS-FNA was compared between patients with and without CP. CP was defined by the presence of more than 4 EUS criteria. RESULTS: Final diagnosis was adenocarcinoma in 210 (70%), benign disease in 64 (21%), other pathology in 19 (6%), and indeterminate in 4 (2%); 3 patients (1%) were lost to follow-up. CP was noted in 75/300 (25%) patients. A lower sensitivity for EUS-FNA was observed in patients with CP than in those without CP (73.9% vs. 91.3%; p = 0.02). While patients with CP had a higher negative predictive value (88.9% vs. 45.5%; p < 0.001), no significant differences were observed for specificity (100% vs. 93.8%), positive predictive value (100% vs. 99.5%), and accuracy (91.5% vs. 91.4%) between those with and without CP. False-negative cytology was encountered in 24 cases: 6/71 (8%) with CP vs. 18/222 (8%) without CP. Patients with CP required more EUS-FNA passes to establish a diagnosis vs. those without CP (median, 5 vs. 2; p < 0.001). On multivariable analysis, age < 50 years (p < 0.001), male gender (p < 0.001), black race (p = 0.001), and the absence of jaundice (p = 0.005) were significantly associated with CP. The impact of EUS-FNA on long-term clinical management was not analyzed. The impact of individual EUS features of CP on sensitivity of EUS-FNA was not evaluated. By protocol, mass lesions that were benign required more passes to definitively exclude malignancy. CONCLUSIONS: EUS-FNA has a low sensitivity for pancreatic-mass lesions in the setting of CP. This decreased sensitivity can be overcome by performing more numbers of passes at FNA, which improves diagnostic accuracy. Demographic features and clinical presentation are predictive of underlying CP in patients with pancreatic-mass lesions.     

Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration

AIM： to evaluate the role of endoscopic ultrasonographyguided fine needle aspiration （EUS-FNA） in the preoperative diagnosis of gastrointestinal stromal tumor （GIST）.
METHODS： From September 2002 to June 2006, Fiftythree consecutive EUS-FNAs of GI tract subepithelial hypoechoic tumors with continuity to proper muscle layer suspected as GIST by standard EUS were evaluated prospectively. The reference standards for the final diagnosis were surgery （n = 31）, or clinical follow-up （n = 22）. Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared.
RESULTS： In 2 cases puncture was not performed because of anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 82% （42/51）. The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 71% （15/21）, 86% （18/21）, and 100% （9/9）,respectively. In 29 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of GIST were 100%（24/24）, 80% （4/5）, 96% （24/25）, 100% （4/4）, and 97% （28/29）, respectively. No major complications were encountered.
CONCLUSION： EUS-FNA with immunohistochemical analysis is a safe and accurate method in the pretherapeutic diagnosis of GIST. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for GIST.     

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration

AIM: To evaluate the diagnostic accuracy of endoscopic ultrasound-guided fi ne-needle aspiration (EUS-FNA) for pancreatic solid tumors larger or smaller than 3 cm, and cystic lesions. METHODS: From January/1997 to December/2006, 611 patients with pancreatic tumors were subjected to EUS-FNA. The fi nal diagnosis was obtained either by surgery (356 cases) or after a mean clinical follow-up of 11.8 mo in the remaining patients. RESULTS: There were 405 solid tumors, 189 cystic lesions and 17 mixed. Pancreatic specimens for cytological assessment were successfully obtained by EUS-FNA in 595 (97.4/) cases. There were 352 (57.6/) malignancies and 259 (42.4/) benign tumors. Among the malignancies, pancreatic adenocarcinomas accounted for 67/ of the lesions. Overall, the sensitivity, specifi city, positive and negative predictive values, and accuracy of EUS-FNA were, respectively, 78.4/, 99.2/, 99.3/, 77.2/ and 87.2/. Specif ically for solid tumors, the same parameters for neoplasms larger and smaller than 3 cm were, respectively, 78.8/ vs 82.4/, 100/ vs 98.4/, 100/ vs 99/, 54.8/ vs 74.1/ and 83.1/ vs 87.8/. For cystic lesions, the values were, respectively, 72.2/, 99.3/, 97.5/, 91/ and 92.2/. CONCLUSION: EUS-FNA can be used to sample pancreatic tumors in most patients. Even though the negative predictive value is inadequate for large solid tumors, the results are rather good for small solid tumors, especially concerning the sensitivity, negative predictive value and diagnostic accuracy. Among all pancreatic lesions, EUS-FNA for cystic lesions canreveal the best negative predictive value and diagnostic accuracy, both higher than 90/.     

谐波造影增强超声内镜在诊断胰腺癌中的作用

目的探讨谐波造影增强超声内镜（CH—EUS）在诊断胰腺癌中的作用。方法选择胰腺占位病变患者为研究对象,以超声内镜引导下细针穿刺（EUS-FNA）或组织病理学及随访结果作为最终诊断,与CH．EUS诊断比较,评价CH—EUS诊断胰腺癌的准确度,并分析CH—EUS在不同胰腺肿瘤中的图像特点。结果共76例患者入选,平均年龄（53．1±14．2）岁,其中胰腺癌35例,局灶肿块型炎症21例,胰腺神经内分泌肿瘤10例,囊腺瘤6例,胰管内乳头状产黏蛋白肿瘤4例。肿瘤最大直径平均（3．4±1．4）cm,〈2cm者18例。CH—EUS诊断胰腺癌的灵敏度97．1％,特异度92．9％,阳性预测值91．7％,阴性预测值97．5％。行EUS．FNA64例,CH-EUS联合FNA对胰腺癌检查的灵敏度达到100％。结论CH—EUS可安全、简便、准确地显示胰腺病变的血供情况,对于胰腺癌诊断的敏感度、特异度均较高,是EUS—FNA的有力补充,值得临床推广应用。     

Endoscopic ultrasound guided fine needle aspiration of solid pancreatic lesions: Performance and outcomes

Background and Aim:  We report our single-centre experience with endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of solid pancreatic lesions with regard to clinical utility, diagnostic accuracy and safety.
Methods:  We prospectively reviewed data on 100 consecutive EUS-FNA procedures performed in 93 patients (54 men, mean age 60.6 ± 12.9 years) for evaluation of solid pancreatic lesions. Final diagnosis was based on a composite standard: histologic evidence at surgery, or non-equivocal malignant cytology on FNA and follow-up. The operating characteristics of EUS-FNA were determined.
Results:  The location of the lesions was pancreatic head in 73% of cases, the body in 20% and the tail in 7%. Mean lesion size was 35.1 ± 12.9 mm. The final diagnosis revealed malignancy in 87 cases, including adenocarcinomas (80.5%), neuroendocrine tumours (11.5%), lymphomas (3.4%) and other types (4.6%). The FNA findings were: 82% interpreted as malignant cytology, 1% as suspicious for neoplasia, 1% as atypical, 7% as benign process and 9% as non-diagnostic. No false-positive results were observed. There was a false-negative rate of 5%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 94.3%, 100%, 100%, 72.2% and 95%, respectively. In 23 (88.5%) of 26 aspirated lymph nodes malignancy was found. Minor complications occurred in two patients.
Conclusions:  Our experience confirms that EUS-FNA in patients with suspected solid pancreatic lesions is safe and has a high diagnostic accuracy. This technique should be considered the preferred test when a cytological diagnosis of a pancreatic mass lesion is required.     

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。