超声内镜引导下行胰腺穿刺活检并发十二指肠穿孔的1例护理

胰腺位于腹膜后,位置较深并且毗邻血管,周围结构复杂,因此,胰腺疾病的定性、定位诊断及鉴别诊断比较困难。超声内镜(Endoscopic UItrasonography,EUS) 是诊断胰腺占位最敏感的技术,也是判断胰腺癌分级的最准确方法之一。在EUS检查基础上,EUS及其引导下的细针抽吸活检术(Fine-needle Aspiration, FNA)可提高胰腺占位诊断的特异性和准确性。EUS-FNA诊断胰腺癌的敏感性达75％～86％[1]。 作为一种新型检查方法,EUS-FNA使用不当可能发生并发症,EUS-FNA相关并发症包括感染、出血、胰腺炎和穿孔等[2,3]。在EUS所有并发症中,最为致命的是穿孔[2]。我院2015年12月收治1例超声内镜引导下行胰腺穿刺术并发十二指肠穿孔,经保守治疗无效后给予急诊手术、积极抗感染治疗、呼吸机辅助呼吸后患者恢复良好     

miR-21、miR-155在胰腺癌患者血浆中的表达及临床意义

目的研究微小RNA-21(miR-21)、微小RNA-155(miR-155)在胰腺癌早期患者血清中的表达水平,探讨其与胰腺癌发病之间的相互关系。方法回顾性采集42例胰腺癌患者、42例慢性胰腺炎患者、42例健康对照组患者血液。利用荧光定量PCR仪对血液中miR-21、miR-155的表达水平进行检测,比较miR-21、miR-155与胰腺疾病临床特征之间的关系,绘制出ROC曲线,判定miR-21与miR-155表达水平与胰腺癌之间存在的联系。结果 miR-21、miR-155在胰腺癌患者血清中表达水平(3.88±3.12,5.29±4.37)高于慢性胰腺炎患者、健康对照组的表达水平(1.09±2.74、0.14±2.59,0.31±3.73、-1.31±3.47),差异有统计学意义(P0.05);慢性胰腺炎患者血浆中miR-21、miR-155表达水平(1.09±2.74,0.31±3.73)稍高于健康对照组(0.14±2.59,-1.31±3.47),但差异无统计学意义(P0.05);miR-21、miR-155在胰腺癌与健康对照组、胰腺癌与慢性胰腺炎组、胰腺癌与慢性胰腺癌+健康对照组3组人群中对胰腺癌的诊断效能的曲线下面积(AUC)分别为0.863(95%CI:0.779,0.938)、0.747(95%CI:0.648,0.833)和0.793(95%CI:0.714,0.873);在鉴别胰腺癌与健康对照组准确性为73.12%、胰腺癌与慢性胰腺炎中为67.81%;在胰腺癌+慢性胰腺炎+健康对照组中诊断胰腺癌的敏感度和特异度分别为70.31%与68.92%,准确性为69.61%。结论胰腺癌患者血浆miR-21与miR-155的表达水平明显异常,可作为胰腺癌早期诊断的依据。     

多层螺旋CT多期扫描诊断胰腺癌临床意义

目的:研究多层螺旋CT多期扫描及影像表现在诊断胰腺癌的临床意义及进展。方法:34例经病理证实胰腺癌,团注法以3～4mL/s速度注入对比剂行动态三期增强扫描,时间分别是20s、40s、65s,层厚层距3～5mm,分析其影像改变,并分析和比较正常胰腺和肿瘤在三期扫描的增强情况,研究其诊断及可切除性评估准确性。结果:34例胰腺癌中胰头癌22例,胰体癌7例,胰尾癌2例,弥漫性分布3例。病灶大小2～11.5cm不等,肿瘤-胰腺对比在动脉期、胰腺期及门脉期分别为(23.25±11.31)、(63.58±26.34)、(43.15±22.53)。根据胰腺癌影像表现,34例中有30例被正确诊断,术前认为可切除14例。结论:多层螺旋CT多期扫描技术在胰腺癌的诊断和可切除性评估上具有重要临床价值。     

基于Logistic回归建立超声联合细针穿刺评估三阴性乳腺癌淋巴结转移的价值

目的探讨超声及超声引导下细针穿刺(FNA)细胞学检查在三阴性乳腺癌淋巴结转移术前评估中的应用价值。方法选取经手术病理及穿刺活检证实为三阴性乳腺癌的66例女性患者,根据病理结果分为转移组35例和反应组31例。对两组检出的淋巴结行多切面扫查,观察其形态、大小、长径与短径的比值(L/S)、皮质回声、淋巴门结构、淋巴结皮质厚度及血供情况。对超声或临床可疑的腋窝淋巴结行超声引导下FNA细胞学检查,以手术病理结果为金标准,评价超声及超声引导下FNA细胞学检查对腋窝淋巴结转移的诊断效能。应用Logistic回归分析建立多指标联合诊断三阴性乳腺癌腋窝淋巴结转移的数学模型,并绘制受试者工作特征(ROC)曲线分析该模型诊断腋窝淋巴结转移的价值。结果转移组L/S≤2、淋巴结边缘形态不规则、淋巴结内部低回声、淋巴门缺失及混合型血流分布的比例均显著高于反应组,差异均有统计学意义(均P0.05)。超声诊断三阴性乳腺癌腋窝淋巴结转移的敏感性、特异性分别为68.57%、64.52%;超声引导下FNA细胞学检查诊断三阴性乳腺癌腋窝淋巴结转移的敏感性、特异性分别为85.71%、83.87%。联合诊断拟合方程为Logit(P)=-5.301+2.860×穿刺结果+3.259×淋巴门+2.326×边缘形态+2.081×L/S。ROC曲线分析显示联合诊断三阴性乳腺癌腋窝淋巴结转移的最佳截断值0.510,敏感性88.57%,特异性96.77%,曲线下面积0.959。结论 FNA细胞学检查联合超声检查指标诊断三阴性乳腺癌腋窝淋巴结转移的准确性优于FNA单独诊断,可更好地指导临床进行术前评估。     

CT和MRI对中晚期胆囊癌周围脏器侵袭和转移的诊断价值

目的比较CT和磁共振成像(MRI)对中晚期胆囊癌周围脏器侵袭和转移的诊断价值。方法回顾性分析54例中晚期胆囊癌患者的CT和MRI检查结果,对CT和MRI检查结果进行比较分析。结果 CT对胆囊癌的诊断符合率为83.33%(45/54),MRI的诊断符合率为90.74%(49/54),两种检查方法诊断符合率比较差异无统计学意义(P0.05)。MRI胆囊癌分期诊断符合率为94.44%(51/54),高于CT的81.48%(44/54),差异有统计学意义(P0.05);MRI对转移、侵袭器官的诊断符合率为89.47%(51/57),高于CT的73.68%(42/57),差异有统计学意义(P0.05)。结论 CT和MRI对胆囊癌的诊断效果无较大差异,在周围脏器侵袭和转移诊断方面MRI优于CT。     

多参数超声联合穿刺诊断三阴性乳腺癌腋窝淋巴结转移

目的:探索常规超声、剪切波弹性成像(SWE)和超声引导下细针穿刺(FNA)联合应用在三阴性乳腺癌(TNBC)腋窝淋巴结转移术前评估中的价值。方法:选择贵州医科大学附属医院经病理证实的TNBC患者作为研究对象。其中转移组48例,反应组57例。对检出的淋巴结进行常规超声及SWE检查,比较转移组与反应组超声及SWE多参数指标。对可疑的腋窝淋巴结进行超声引导下FNA细胞学检查,评价常规超声、SWE、FNA及三者联合对TNBC腋窝淋巴结的诊断效能。结果:转移组淋巴结长径(L)/短径(S)比值(L/S)≤2、形态不规则、淋巴门缺失以及未见淋巴门型血流分布的患者比例多于反应组,杨氏模量(YM)平均值高于反应组,差异均具有统计学意义(均P<0.05)。SWE对TNBC转移性腋窝淋巴结的诊断敏感性(87.50%)高于常规超声(79.17%)及FNA(75.00%);而FNA诊断TNBC转移性腋窝淋巴结的特异性(94.74%)高于SWE(82.46%)和常规超声(70.18%)。三者联合诊断拟合方程为Logit(P)=-5.301+5.860×FNA阳性+2.259×L/S≤2+1.326×形态不规则+4.081×淋巴门缺失+2.729×未见淋巴门型血流+0.121×YM平均值。三者联合的敏感性为97.92%,高于常规超声、SWE及FNA,特异性为87.72%,稍低于FNA,但明显高于常规超声及SWE。结论:常规超声、SWE与腋窝淋巴结FNA联合提高了诊断TNBC腋窝淋巴结转移的准确性。     

超声内镜对上消化道占位性病变诊断价值

目的探讨超声内镜(endoscopic ultrasonography,EUS)对上消化道占位性病变诊断的价值。方法以122例在电子胃镜及电子线阵式超声内镜检查后接受内镜下黏膜切除术(endoscopic mucosal resection,EMR)或内镜下黏膜剥离术(endoscopic mucosal dissection,ESD)或外科手术(后统称为手术)的上消化道占位性病变的患者为研究对象,其中33例患者行细针穿刺抽吸细胞学检查(fine-needle aspiration,FNA)。将电子胃镜与EUS检查结果与术后病理诊断进行比较。结果 122例EUS(部分结合FNA)与术后病理的符合率为91.8%(112/122),33例EUS-FNA与术后病理的符合率为96.9%(32/33),电子胃镜检查与术后病理的符合率为77.2%(71/92)。与电子内镜诊断符合率相比,EUS有明显优势。结论 EUS能满意的对上消化道占位性病变进行初步定性诊断,结合FNA检查能有效提高诊断的准确性。     

胰腺癌患者手术前后外周血淋巴细胞亚群和血小板变化

目的测定胰腺癌患者手术前后外周血淋巴细胞亚群和血小板(PLT)水平,并探讨其与胰腺癌患者临床病理参数的相关性。方法选取66例胰腺癌患者(胰腺癌组),以64名体检健康者作为对照组。检测所有对象淋巴细胞亚群[CD3~+T细胞、CD3~+CD4~+T细胞、CD3~+CD8~+T细胞、B细胞和自然杀伤(NK)细胞]及PLT水平,分析其与胰腺癌临床病理参数的相关性。结果与对照组相比,胰腺癌组术前外周血CD3~+T细胞和CD3~+CD4~+T细胞水平明显降低(P0.05),CD3~+CD8~+T细胞和PLT水平明显升高(P0.05);胰腺癌组术后CD3~+T细胞和CD3~+CD4~+T细胞水平较术前明显升高(P0.05),PLT较术前明显降低(P0.05);胰腺癌组术后与对照组之间CD3~+T细胞、CD3~+CD4~+T细胞、CD3~+CD8~+T细胞、B细胞、NK细胞和PLT水平差异均无统计学意义(P0.05);胰腺癌组术前外周血CD3~+T细胞、CD3~+CD4~+T细胞、CD3~+CD8~+T细胞、B细胞、NK细胞、PLT水平与患者年龄、肿瘤大小、肿瘤部位、有无神经浸润、分化程度无关(P0.05);外周血CD3~+CD4~+T细胞、PLT水平与胰腺癌不同组织分级、有无淋巴结转移有关(P0.05)。胰腺癌组术前外周血CD3~+CD4~+T细胞水平与PLT水平呈负相关(r=-0.44,P0.01)。结论胰腺癌患者细胞免疫功能术前处于被抑制状态,术后可基本恢复正常。胰腺癌患者术前淋巴细胞免疫异常与PLT水平、胰腺癌组织分级和淋巴结转移相关。     

聚焦超声消融联合程序性死亡受体-1单抗治疗晚期胰腺癌的疗效分析

目的 初步评价聚焦超声消融(FUA)联合程序性死亡受体-1(PD-1)单抗治疗晚期胰腺癌的有效性和安全性。方法 回顾性分析51例接受单独FUA治疗与FUA联合PD-1治疗的晚期胰腺癌患者。记录治疗的局部疗效、生存时间、不良反应及治疗前后T细胞亚群，分析患者预后的差异及影响总生存期的因素。结果 联合组24例，FUA治疗组27例；联合组、FUA治疗组患者的中位无进展生存时间(PFS)分别为8.9、6.5个月，中位生存时间(OS)为11、9.4个月，联合组的PFS、OS显著优于FUA治疗组(P<0.05);Kaplan-Meier生存分析及多因素分析提示全麻和消融疗效是联合组患者生存时间的独立影响因素(P<0.05);Spearman相关性分析提示联合组患者治疗前CD4⁺T、Treg、CD4⁺初始T、CD4⁺记忆T细胞比例与患者OS呈正相关，治疗前CD8⁺T细胞比例与患者OS呈负相关(P<0.05)。结论 FUA联合PD-1与单FUA治疗相比，可延长晚期胰腺癌患者的生存时间，不良反应少，...     

ACE、ACE/ACE2对胰腺癌的临床诊断价值初探

目的:探讨血清ACE、ACE2以及其比值对胰腺癌的临床诊断价值。方法:用ELISA方法检测15例胰腺癌患者、10例胰腺癌术后无复发患者、10例单纯CA199升高患者、10例胰腺炎患者及10例健康体检者血清ACE、ACE2、ACE/ACE2的含量,胰腺癌组分别与良性病变组和正常对照组比较。结果:胰腺癌组中ACE、ACE/ACE2分别为(275.340±247.042)、(0.482±0.398)pg/m L,相较胰腺癌术后无复发组、单纯CA199升高组、胰腺炎组和对照组明显升高,差异具有统计学意义(P0.01)。CA199升高组ACE2水平为(628.343±114.383)pg/m L,明显低于对照组(948.89±496.498)pg/m L(P0.05)。胰腺炎组ACE2为(515.078±157.815)pg/m L,显著低于对照组。但CA199升高组与胰腺炎组之间无统计学差异(P0.05)。结论:血清ACE、ACE/ACE2在胰腺癌的诊断中有一定的临床应用价值,可为胰腺癌的诊断提供新的方法。     

Utility of Endoscopic Ultrasound (EUS)-Guided Fine-Needle Aspiration for Peri-arterial Soft Tissue Cuffs Without Identifiable Pancreas Mass on CT and EUS: A Prospective Comparative Study

Pancreatic cancer may present as a peri-arterial soft tissue cuff (PSTC) around the superior mesenteric artery or celiac axis without an identifiable pancreatic mass. We evaluated the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with a PSTC without definite pancreas involvement and those with a typical pancreatic mass. The patients who underwent EUS-FNA of a PSTC without pancreatic involvement were prospectively enrolled. The patients who underwent EUS-FNA for a pancreatic mass were recruited as a control group. A total of 224 patients underwent 247 EUS-FNAs. Among the 13 patients with a PSTC, 11 were positive for malignancy as determined by EUS-FNA, with 5 diagnosed after the first session and 6 after the second session. The diagnostic yield of PSTCs by EUS-FNA was significantly lower than that for typical pancreatic masses (65% vs. 87%, p = 0.02). An on-site cytopathologist and repeated EUS-FNA are recommended to improve the diagnostic accuracy of this disease entity.     

超声内镜引导下细针抽吸活检术在胰腺占位性病变中的应用

目的 探讨超声内镜引导下细针抽吸活检术（EUS-FNA）在胰腺占位性病变中的临床应用特点。方法 选择2018年1月～2022年1月于本院因可疑胰腺占位性病变行EUS-FNA检查的55例患者作为研究对象,患者年龄62.91±11.21岁,其中男性29例、女性26例。以穿刺样本的组织学病理结果为金标准,分析行EUS-FNA检查患者的一般临床资料及其病变特点、胰管情况、穿刺次数及术后并发症等。评价EUS-FNA诊断胰腺占位性病变的敏感度、特异性、准确度,以及影响准确性的临床因素。结果55例患者均成功进行EUS-FNA,穿刺成功率100%,所有患者获得穿刺病理。术后不良反应2例,其中1例为腹痛,1例为高淀粉酶血症,经临床常规处理后均恢复良好。经EUS-FNA诊断明确的有48例（87.27%）,诊断未明确的有7例（12.73%）,诊断敏感度为92.31%(48/52),特异性为100%(3/3),准确度为92.73%(51/55),阳性预测值为100%(48/48),阴性预测值为42.86%(3/7);EUS-FNA的准确性与患者年龄、胰管扩张情况有关（P<0.05）,与性别、血糖、肿瘤标...     

术前血清CA125预测血清CA19-9正常胰腺癌患者术后生存的价值

目的:分析糖类抗原125(CA125)在CA19-9正常胰腺癌人群中的预后预测价值。方法:回顾性分析2010年3月至2015年12月在复旦大学附属肿瘤医院胰腺肿瘤研究所接受根治性切除的182例术前CA19-9正常胰腺癌患者的临床资料。分析血清CA125与患者临床病理特征的关系。采用Kaplan-Meier生存曲线和多因素Cox回归分析模型分析血清CA125对患者预后的预测价值。结果:术前血清CA125高水平患者的肿瘤分化程度越差(P=0.013),淋巴结转移发生率更高(P=0.016)。术前血清CA125高水平患者的中位总生存时间(OS,16.8个月)和无复发生存时间(RFS,10.4个月)显著短于术前血清CA125低水平患者(OS:>24.3个月,P<0.001;RFS:16.3个月,P=0.001)。多因素Cox回归分析显示,术前血清CA125高水平是术前血清CA19-9正常胰腺癌患者OS(风险比=2.171,95%置信区间1.229~3.836,P=0.008)和RFS(风险比:1.648,95%置信区间1.114~2.438,P=0.012)短的独立预测因子。结论:术前血清CA125是术前血清CA19-9正常胰腺癌患者的独立预后预测因子,能为患者术后辅助治疗策略的选择提供依据。     

急性髓系白血病-M_4型患者的特征及预后

目的 探讨影响急性髓系白血病(AML)-M_4型患者生存、预后的主要因素.方法 70例AML-M_4患者分为二组:①伴嗜酸粒细胞比例增高但不伴有inv(16)[Eos~+inv(16)~-]组;②嗜酸粒细胞比例增高伴有inv(16)[Eos~+inv(16)~+]组;③不伴有嗜酸粒细胞比例增高(Eos~-)组.总结分析患者临床表现、免疫分型、染色体核型及生存情况,分析影响总体生存(OS)时间、尢复发生存(RFS)时间的因素.结果 70例AML-M_4患者完全缓解(CR)率85.7%,其中1个疗程CR率71.4%;所有患者的中位OS期为20.0(1.2～162.4)个月,达CR患者的中位RFS期为78.0(1.2～129.5)个月;3年、5年OS率分别为42%、42%,3年、5年RFS率分别为59%、54%.Eos组总体CR率76.9%,1个疗程CR率61.5%,中位OS期为11.2个月,中位RFS期为10.8个月;Eos~+组总体CR率96.8%,1个疗程CR率89.6%,中位OS、RFS期未达.统汁学分析表明,两组在总体CR率、OS和RFS期差异均有统计学意义.Eos~+组内分析表明,Eos~+inv(16)~+组总体CR率达100%,1个疗程CR率达94.4%,中位OS、RFS期未达;Eos~+inv(16)~-组总体CR率达91.7%,1个疗程CR率达69.2%,中位OS期为14.3个月,中位RFS期为12.4个月.统汁学分析表明,Eos~+inv(16)~+组、Eos~+inv(16)~-组OS、RFS期差异均有统计学意义.结论单独伴有Eos比例升高可作为AML-M_4患者预后良好因素之一,其中Eos~+inv(16)~+组预后最好.Eos~+组患者具有发病年龄较小、血小板计数低的特点.     

Prevalence and significance of periduodenal venous collaterals in patients evaluated for pancreaticobiliary disorders by endosonography

BACKGROUND AND STUDY AIMS: The prevalence of periduodenal venous collaterals detected by endoscopic ultrasonography (EUS) in patients undergoing evaluation for pancreaticobiliary disorders, and their influence on the success of transduodenal fine-needle aspiration (FNA) of solid pancreatic masses is not known. PATIENTS AND METHODS: Records for all consecutive patients who underwent EUS for pancreaticobiliary disorders over a 14-month period were reviewed. EUS was carried out by a single endosonographer using a radial echo endoscope. When FNA was attempted, a curvilinear-array echo endoscope was used in conjunction with color flow Doppler. Periduodenal and perigastric collaterals were defined as multiple anechoic serpiginous structures imaged from the duodenal bulb, the second portion of duodenum, or the stomach. Established criteria were used to assess the presence of chronic pancreatitis. RESULTS: Over the study period, 338 patients (mean age 58.9 +/- 14.5 years; 52 % women) underwent EUS for pancreaticobiliary disorders. Periduodenal collaterals were detected in 22 patients (6.5 %), 21 of whom (19 %) had pancreatic cancer. Patients with pancreatic cancer were significantly more likely to have periduodenal collaterals in comparison with those without pancreatic cancer (OR 25; 95 %CI, 5.75 - 109; P = 0.001). Computed tomography detected collaterals in only two of the 22 patients (9.1 %). Periduodenal collaterals made transduodenal FNA impossible in nine of the 22 patients (41 %). However, in these patients a cancer diagnosis was obtained using EUS-FNA from liver lesions in two cases; using a transgastric approach in two (pancreatic neck lesions); and atypical cells were obtained in two. A safe window could not be achieved in three patients (13.6 %). Transduodenal FNA was performed by avoiding the collaterals and was successful in 13 of the 22 patients, with no bleeding complications. CONCLUSIONS: Periduodenal collateral vessels are infrequent in patients with suspected pancreaticobiliary disease, but are relatively common in patients with pancreatic cancer. Transduodenal EUS-FNA can be carried out safely in the majority of cases in the presence of periduodenal collaterals, but collaterals may occasionally hamper successful transduodenal pancreatic FNA.     

超声引导经皮穿刺活检对胰腺占位性病变的诊断价值:病例对照研究

  目的  评估超声引导经皮穿刺活检对胰腺占位性病变的诊断价值及安全性,对比分析细针抽吸活检(fine needle aspiration,FNA)和粗针穿刺活检(core needle biopsy,CNB)的诊断效力。  方法  回顾性分析2014年1月至2017年4月北京协和医院经影像学检查发现胰腺肿物并接受超声引导下经皮胰腺肿物活检患者的临床资料。按照穿刺方法不同分为FNA和CNB两组,每组随访至少6个月,根据手术病理、重复活检或随访的临床进展确定最终诊断,对比两种活检方法的灵敏度、特异度、阳性预测值、阴性预测值和准确度。  结果  共160例符合纳入和排除标准的患者入选本研究,其中FNA组95例,CNB组65例,超声引导经皮穿刺活检的总体灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为93.8%、100%、100%、64.0%、94.4%。CNB的灵敏度、阴性预测值和准确度稍高于FNA(94.7%比93.1%,72.7%比57.1%,95.4%比93.7%),但两种方法的灵敏度、特异度、阳性预测值、阴性预测值、准确度差异并无统计学意义。主要并发症2例(1.3%,2/160),包括1例急性胰腺炎和1例穿刺后针道种植。  结论  超声引导经皮穿刺活检对于胰腺占位性病变是一种有效、安全的诊断方法, FNA和CNB的诊断效力在本研究中差异并不显著。     

Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions

BACKGROUND AND STUDY AIMS: It is still difficult to differentiate reliably between benign and malignant biliary tract lesions. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has added to the diagnostic power of EUS for other gastrointestinal tumors. A retrospective analysis of experience with FNA sampling of bile duct lesions was therefore carried out. PATIENTS AND METHODS: All EUS-FNA procedures for bile duct masses or strictures were analyzed at our tertiary referral center from May 2000 through October 2002. Data for EUS findings, the results of EUS-FNA, and tissue sampling at surgery were included. EUS-FNA procedures were carried out using a 22-gauge needle. An experienced cytopathologist was present during FNA in all but three cases. Clinical follow-up details were recorded when available for patients in whom a suitable diagnostic gold standard was not available for comparison. RESULTS: A total of 35 patients underwent EUS-FNA of bile duct lesions during the study period. There were no complications. Data for EUS-FNA of bile duct masses or strictures and tissue obtained at surgery were available for 23 patients. If positive cytology at surgical pathology is taken as the gold standard, EUS-FNA has a diagnostic yield for cancer of 100 % (if atypia/inconclusive findings in the FNA sample are regarded as benign). Eleven patients had a definite malignancy on surgical pathology. Of these 11 patients, five had a finding of malignancy on EUS-FNA, giving a sensitivity of 45 % (if FNA cytology reported as atypia/inconclusive is regarded as benign). Twelve patients had findings of no malignancy from tissue obtained at surgery. Of these 12 patients, nine had benign pathology and three had atypia/inconclusive findings in the EUS-FNA sample (specificity of 100 % if atypia/inconclusive findings are considered benign). A further 12 patients did not have surgical specimens for comparison with EUS-FNA results. Four patients had definite findings of malignancy on EUS-FNA alone, and one patient had FNA findings suspicious for malignancy. Seven patients had negative or equivocal EUS-FNA results. These 12 patients are described but excluded from further analysis, as a gold standard was not available for comparison. However, clinical follow-up data were available for eight of these 12 patients, and in each case the follow-up findings were compatible with previous benign or malignant EUS-FNA findings. CONCLUSIONS: The practice of EUS-FNA has improved the diagnostic yield of EUS. These results suggest that it is a safe and useful procedure for investigating biliary masses or strictures that have hitherto caused considerable diagnostic confusion, especially in patients with negative brush cytology findings. The possibility of false-negative findings remains, but core biopsy needles may improve the situation. The results of further studies are awaited.     

Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration

BACKGROUND AND STUDY AIMS: The accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) depends on immediate specimen review by a cytopathologist. Stromal tumors, lymphoma, and well-differentiated pancreatic cancer are difficult to diagnose on the basis of cytology alone. To overcome these limitations, a 19-gauge Trucut needle has been developed to obtain histological samples at EUS. This pilot study compares the specimen adequacy and diagnostic accuracy of EUS-guided Trucut needle biopsy (EUS-TNB) with EUS-FNA. PATIENTS AND METHODS: A total of 18 patients underwent EUS-TNB and EUS-FNA. The specimen adequacy and diagnostic accuracy of the two techniques was compared. The technical performance and safety profile of the Trucut needle were also evaluated. RESULTS: The EUS-TNB specimen was adequate for evaluation in 15/18 patients compared with 18/18 with EUS-FNA (83 % vs. 100 %, not significant). The diagnostic accuracy of EUS-TNB was not significantly different from EUS-FNA (78 % vs. 89 %). Two complications were encountered: one patient developed mediastinitis and required surgery; another had immediate bleeding that was managed conservatively. One technical problem was encountered: the Trucut needle failed to deploy after two passes when a gastric stromal cell tumor was being biopsied. CONCLUSION: The diagnostic accuracy of the new EUS-TNB is comparable to that of EUS-FNA. In our experience, the overall efficacy and safety profile of the Trucut needle appears modest.     

Comparison of smear cytology with liquid-based cytology in pancreatic lesions: A systematic review and meta-analysis

BACKGROUNDEndoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) is a safe and accurate technique to confirm the diagnosis of pancreatic cancers. Recently, numerous studies comparing the diagnostic efficacy of smear cytology (SC) and liquid-based cytology (LBC) for pancreatic lesions yielded mixed results.AIMTo compare and identify the better cytology method for EUS-FNA in pancreatic lesions.METHODSA comprehensive search of PubMed, Embase, and Cochrane was undertaken through July 18, 2020. The primary endpoint was diagnostic accuracy (sensitivity and specificity). Secondary outcomes included sample adequacy and post procedure complications. In addition, factors affecting diagnostic efficacy were discussed.RESULTSData on a total of 1121 comparisons from 10 studies met the inclusion criteria. Pooled rates of sensitivity for SC and LBC were 78% (67%-87%) vs 75% (67%-81%), respectively. In any case, both SC and LBC exhibited a high specificity close to 100%. Inadequate samples more often appeared in LBC compared with SC. However, the LBC samples exhibited a better visual field than SC. Very few post procedure complications were observed.CONCLUSIONOur data suggested that for EUS-FNA in pancreatic lesions (particularly solid lesions), SC with Rapid On-Site Evaluation represents a superior diagnostic technique. If Rapid On-Site Evaluation is unavailable, LBC may replace smears. The diagnostic accuracy of LBC depends on different LBC techniques.     

以HAA方案诱导治疗成人初发急性髓系白血病疗效观察

目的 对1999年5月至2004年12月收治的80例成人初发急性髓系白血病(AML)患者,以HAA(高三尖杉酯碱、阿糖胞苷、阿柔比星)方案进行诱导治疗,探讨该方案治疗成人初发AML患者的有效性和安全性.方法 初发AML患者80例以HAA方案诱导治疗,计算完全缓解(CR)率,并采用Kaplan-Meier方法评估患者的无复发生存(RFS)率,组间患者RFS差异用Log-rank检验.结果 80例患者CR率为81%,其中1个疗程CR率为75%.除外4例早期死亡患者,76例患者中位随访时间为26(2～69)个月,3年预计总生存(OS)率为51%.对于达到CR的患者,3年预计RFS率为53%.按FAB分型分组,M5组CR率为74%,其CR患者的3年预计RFS率为75%,M1/M2组CR率为87%,其CR患者的3年预计RFS率为37%.按染色体核型分组,低危组、中危组与高危组的CR率分别为100%,83%和20%,其中低危组3年OS率为76%,中危组为50%,高危组的中位生存时间仅有6个月.结论 HAA方案可以作为成人初发AML患者的首选方案.通过1～2个疗程的化疗,能够获得比较高的CR率以及RFS率.