细胞块结合免疫组化在内镜超声引导下穿刺诊断胰腺实性占位中的应用价值

目的探讨超声内镜引导下细针穿刺（EUS—FNA）物行不同细胞学检查方法对胰腺占位性病变的诊断价值。方法前瞻性研究广西医科大学第一附属医院2012年3月至2013年6月收治的胰腺实性占位性病变72例,均行超声内镜引导下细针穿刺活检取材,分别行常规涂片、液基涂片及细胞块结合免疫组化检查。结果72例患者中,最终确诊胰腺肿瘤61例,包括胰腺癌55例、胰腺假乳头状瘤2例、胰腺内分泌肿瘤4例;良性病变11例,包括慢性胰腺炎4例、胰腺结核2例、胰腺炎4例、黏液性囊腺瘤1例。常规涂片、液基涂片和细胞块结合免疫组化对胰腺肿瘤的诊断敏感度分别为68．9％（42／61）、75．4％（46／61）和90．2％（55／61）,特异度均为100．0％,准确率分别为73．6％（53／72）、79．2％（57／72）和91．7％（66／72）,细胞块结合免疫组化诊断准确率高于常规涂片细胞学及液基细胞学（P均〈0．05）。术后患者均无出血、感染、急性胰腺炎等并发症。结论EUS—FNA是一种安全有效的诊断胰腺占位病变的方法,具有高敏感度和特异度。EUS—FNA细胞块结合免疫组化有助于胰腺实性占位病变的定性诊断和组织学分型诊断,对治疗方案的选择有较大的临床应用价值。     

线阵式超声内镜引导下细针针吸活组织检查对粘膜下病变的诊断价值

目的 通过内镜超声检查（EUS）结合细针针吸活组织检查（简称活检）来确定粘膜下病变的起源和性质,并评价这种方法对粘膜下病变诊断的价值。方法 经胃镜发现28例食管、胃实质性粘膜下病变的患者,对他们进行超声内镜检查,以明确其来源的层次、病变的位置,观察有无淋巴结转移。排除腔外正常组织压迫,在超声内镜引导下对病变行细针针吸活检,结果 28例患者中2例经EUS证实为腔外正常组织压迫,余26例患者均行EUS引导下的细针针吸活检,3例患者穿刺取材失败,23例患者经细胞学或组织学分析显示4例恶性肿瘤（淋巴瘤2例,平滑肌肉瘤2例）及19例良性病变（平滑肌瘤18例,脂肪瘤1例）,全部20例经手术、1例经内镜电切及7例经临床随访验证。结论 EUS结合细针穿刺活检是诊断粘膜下病变安全、有效的方法。     

内镜超声引导下细针穿刺活检对胰腺占位性病变的诊断价值

目的探讨内镜超声引导下细针穿刺活检（EUS—FNA）对胰腺占位性病变的诊断价值。方法从1998年10月至2006年9月，对190例胰腺占位病灶进行了超声内镜引导下穿刺活检，进行细胞学或病理学诊断。结果（1）2006年1月以前未采用床旁染色观察时，EUS—FNA诊断胰腺癌的敏感性为67．6％。2006年1月以后采用病理医师床旁瑞氏-姬姆萨快速染色观察法，EUS—FNA诊断胰腺癌的敏感性提高到93.1％。（2）18例胰腺小占位病灶行EUS—FNA，其诊断准确率是66．7％。（3）胰腺癌患者组中EUS—FAN活检物中的CEA、CA19-9浓度明显高于血清中的浓度。（4）EUS—FNA对假肿瘤性胰腺炎诊断的准确率为76．5％。结论EUS—FNA对胰腺占位性病灶的诊断是安全有效的，具有重要价值。     

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。     

胰腺超声内镜细针穿刺活检物中K—ras基因定量检测对胰腺癌诊断价值的研究

目的比较不同胰腺超声内镜细针穿刺物中K—ras突变定量值,评价其对胰腺癌辅助诊断的价值。方法收集53例胰腺占位病变的超声内镜细针穿刺物,采用肽核酸（PNA）钳制实时定量PER的方法检测K—ras基因野生及突变拷贝数,根据临床综合诊断,与细胞学比较,评价其诊断价值。结果53例患者最后确诊为胰腺癌37例,非恶性胰腺占位16例,胰腺癌组K—ras基因的突变率为83．8％,非恶性胰腺占位组突变率为18．8％,两组之间比较差异有统计学意义（P〈0．05）。细胞学和K—ran定量检测诊断的灵敏度分别为59．5％和83．8％,将两者联合后诊断胰腺癌的灵敏度可提高至89．2％。结论胰腺组织超声内镜细针穿刺物中K—ras定量检查对胰腺癌有临床辅助诊断价值。     

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。     

线阵式超声内镜引导下细针穿刺活检对粘膜下病变的诊断价值

目的 通过内镜超声检查(EUS)结合细针穿刺活检来确定粘膜下病变的起源和性质,并评价这种方法对粘膜下病变诊断的意义。方法 经胃镜发现28例食管胃实质性粘膜下病变的患,对他们进行超声内镜检查,以明确其来源的层次、病变的位置,观察有无淋巴结转移。排除腔外正常组织压迫,在超声内镜导引下对病变行细胞针穿刺活检。结果 28例患中,2例经EUS证实为腔外正常组织压迫,余26例患均行EUS导此下的细针穿刺活组织检查。3例患穿刺取材失败。23例患经细胞学分析显示4例恶性肿瘤(淋巴瘤2例,平滑肌肉瘤2例)及19例良性病变(平滑肌瘤18例,脂肪瘤1例)。全部病例20例经手术、1例经内镜电切及7例经临床随访验证。结论 EUS结合细针穿刺活检是诊断粘膜下病变安全、有效的方法。     

内镜超声(EUS)、CT/超声引导和手术获取胰腺组织标本的敏感性和特异性比较

胰腺的细针穿刺活检常被用于鉴别胰腺恶性病变、局灶性慢性胰腺炎和胰腺的转移性肿瘤 ,胰腺的细针穿刺活检可经内镜超声 (EU S)、CT、超声 (US)引导和经外科手术引导 ,本文回顾性比较了 5年间经内镜超声 ,CT/ US引导和外科手术获取胰腺组织标本的敏感性和特异性。材料和方法　 1993年 1月至 1998年 3月有 12 8例患者进行胰腺细针穿刺活检 ,共获取 14 9份胰腺组织标本 ,其中经 EUS引导细针穿刺获取胰腺组织标本 6 8份 ,经 CT/ US引导细针穿刺获取胰腺组织标本 70份 ,经外科手术获取胰腺组织标本 11份。对所有经历胰腺活检的患者的所…     

超声内镜引导下细针穿刺/活检对于胰腺占位性病变诊断的影响因素分析

超声内镜引导下细针穿刺/活检术对胰腺肿瘤的诊断，无论是在敏感性、特异性还是准确性方面均具有较高的诊断价值。各种技术上的改变，不仅包括但不限于针头大小、针型、针随病变内移动方式，还包括医师水平、针头加速度等均可影响其诊断阳性率。本文就超声内镜引导下细针穿刺/活检技术的影响因素作一综述。     

内镜超声引导下细针穿刺活检诊断胰腺占位性病变28例

胰腺占位性病变位于腹膜后,位置较深并且毗邻血管,周围结构复杂,因此,其定性及定位诊断有时比较困难.超声内镜的应用显著提高了对此类疾病的诊断水平,而内镜超声引导下细针穿刺活检（EUS-FNA）更能直接、快速地获取胰腺组织以明确诊断,本研究旨在对胰腺占位性病变行EUS-FNA的临床价值及安全性作一评价.     

Performance of endosonography-guided fine needle aspiration and biopsy in the diagnosis of pancreatic cystic lesions

OBJECTIVE: Preoperative diagnosis of cystic lesions of the pancreas remains difficult despite improvement in imaging modalities and cystic fluid analysis. The aim of our study was to assess the performance of endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (FNA) in the diagnosis of pancreatic cystic lesions. METHODS: Data from a series of 127 consecutive patients with pancreatic cystic lesions were prospectively studied. EUS and EUS-guided FNA were performed in all patients, and cystic material was used for cytological and histological analysis as well as for biochemical and tumor markers analysis. Performance of EUS diagnosis, biochemical and tumor markers, and FNA diagnosis were compared with the final histological diagnosis obtained at surgery or postmortem examination. Sixty-seven patients underwent surgery and therefore constituted our study group. RESULTS: EUS provided a tentative diagnosis in 113 cases (89%). Cytohistological FNA provided a diagnosis in 98 cases (77%). When the results of EUS and EUS-guided FNA were compared with the final diagnosis (67 cases), EUS correctly identified 49 cases (73%), whereas FNA correctly identified 65 cases (97%). Sensitivity, specificity, positive predictive value, and negative predictive value of EUS and EUS-guided FNA to indicate whether a lesion needed further surgery were 71% and 97%, 30% and 100%, 49% and 100%, and 40% and 95%, respectively. Carbohydrate antigen 19-9 > 50,000 U/ml had a 15% sensitivity and a 81% specificity to distinguish mucinous cysts from other cystic lesions, whereas it had a 86% sensitivity and a 85% specificity to distinguish cystadenocarcinoma from other cystic lesions. CONCLUSIONS: EUS-guided FNA is a valuable tool in the preoperative diagnostic assessment of pancreatic cystic lesions.     

Endosonographically controlled fine needle aspiration cytology--indications and results in routine diagnosis]

The usefulness and clinical utility of routine EUS-guided fine needle aspiration cytology (FNA) in the diagnosis of lesions adjacent to the upper gastrointestinal tract was prospectively studied. METHODS: EUS/FNA was performed in 122 patients for 125 lesions: Mediastinal lymph nodes (n = 56), pancreatic lesions (n = 45), paragastric masses (n = 12), submucosal tumors (n = 4) and small hepatic lesions (n = 2) were successfully punctured for cytological diagnosis. RESULTS: Adequate material was gained in 119 out of 125 punctures (95%). Overall sensitivity, specifity, positive and negative predictive value were 90%, 98%, 98% and 89%. Results of EUS/FNA in mediastinal lymph nodes were superior (95%, 100%, 100%, 90%) to those in pancreatic lesions (80%, 100%, 100%, 80%). In paragastric masses sensitivity was 100% whereas specifity was only 67%--due to one false-positive result. Out of four submucosal tumors diagnosis was revealed in three. Two liver metastasis were successfully punctured. 35 out of 56 mediastinal nodes showed malignancy. 27 metastases of lung-, three of gastric-, two of renal cancer and three Non-Hodgkins's lymphoma were diagnosed. The cytological results of 45 pancreatic lesions showed cancer in 19 and chronic inflammation in 21, two abscesses and three benign cysts. There were no complications. 37 patients were treated on outpatient's basis. CONCLUSIONS: EUS-guided FNA is an accurate and safe technique to sample cytology from lesions adjacent to the wall of the upper gastrointestinal tract. New indications may be established for the diagnosis of lung cancer or metastases of other spreading out into the mediastinum or the celiac axis.     

Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses： A multicenter study

AIM： To evaluate the ability of endoscopic ultrasound （EUS） elastography to distinguish benign from malignant pancreatic masses and lymph nodes.
METHODS： A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass （n = 121） or lymph node （n = 101）, The classification as benign or malignant, based on the real time elastography pattern, was compared with the classification based on the B-mode EUS images and with the final diagnosis obtained by EUS-guided fine needle aspiration （EUS- FNA） and/or by surgical pathology. An interobserver study was performed.
RESULTS： The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%, respectively, compared to 92.3% and 68.9%, respectively, for the conventional B-mode images. The sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%, respectively, compared to 78.6% and 50.0%, respectively, for the B-mode images. The kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph nodes.
CONCLUSION： EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity, specificity and accuracy. It might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.     

细针直径对内镜超声下胰腺实性占位穿刺诊断影响的研究

目的研究不同细针直径对内镜超声(EUS)引导下细针穿刺(FNA)胰腺实性占位诊断的影响。方法选择临床及影像学疑诊胰腺实性占位患者共37例,分别用19G和22G穿刺针进行穿刺。结果EUS检出全部37例胰腺占位,16例患者经22G穿刺针行FNA,11例获得满意标本;21例患者经19G穿刺针行FNA,均获得满意标本。32例获得病理诊断,其中3例误诊为慢性胰腺炎。结论EUS能有效检出胰腺占位,穿刺针大小为穿刺组织病理诊断成功的影响因素,慢性胰腺炎是影响病理诊断的重要因素。     

ENDOSCOPIC ULTRASOUND‐GUIDED FINE‐NEEDLE ASPIRATION BIOPSY FOR THE DIAGNOSIS OF GASTROINTESTINAL SUBMUCOSAL TUMORS

Gastrointestinal submucosal tumors (SMT) detected by barium meal study or endoscopy include various kinds of diseases and various degrees of malignancy. Endoscopic ultrasonography (EUS) can provide useful information about the differentiation of intra‐ and extra‐wall lesions, location and originating layer, presumption of their histological nature, measurement of the actual size of the lesion, and the possibility of differentiating between a benign and a malignant lesion. However, EUS alone does not reveal the complete pathology. EUS fine‐needle aspiration biopsy (EUS‐FNAB) has been reported to be a useful tissue sampling method for pancreatic mass lesions, lymph nodes swelling, posterior mediastinal masses and also gastrointestinal submucosal tumors. The EUS‐FNAB procedure is effective not only for the differential diagnosis of benignancy and malignancy, but also for the specific histopathological nature of gastrointestinal SMT using immunohistochemical staining. When used with MIB‐1 (Ki‐67) staining, and gene analysis in case of gastrointestinal stromal tumor, EUS‐FNAB may indicate its prognosis and influence decisions regarding therapeutic strategy. Thus, EUS‐FNAB is an indispensable procedure in the diagnosis of SMT.     

Prospective risk assessment of bacteremia and other infectious complications in patients undergoing EUS-guided FNA

BACKGROUND: There are few data regarding the risk of bacteremia with EUS-guided FNA. This study prospectively evaluated the frequency of bacteremia and other infectious complications after EUS-guided FNA. METHODS: Patients referred for EUS-guided FNA of the upper GI tract lesions were considered for enrollment. Patients were excluded if there was an indication for preprocedure administration of antibiotics based on ASGE guidelines, had taken antibiotics within the prior 7 days, or if they had a pancreatic cystic lesion. Blood cultures were obtained immediately before the procedure, after routine endoscopy/radial EUS, and 15 minutes after EUS-guided FNA. RESULTS: Fifty-two patients underwent EUS-guided FNA at 74 sites (mean 1.4 sites/patient) totaling 266 passes of the fine needle (mean 5.1 FNA/patient). Coagulase negative Staphylococcus was grown in cultures from 3 patients (5.8%; 95% CI [1%, 15%]) and was considered a contaminant. Three patients (5.8%; 95% CI [1%, 15%]) developed bacteremia: Streptococcus viridans (n = 2), unidentified gram-negative bacillus (n = 1). No signs or symptoms of infection developed in any patient. CONCLUSION: EUS-guided FNA of solid lesions in the upper GI tract should be considered a low-risk procedure for infectious complications that does not warrant prophylactic administration of antibiotics for prevention of bacterial endocarditis.     

ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study

BACKGROUND: The accuracy of ERCP-based brush cytology or forceps biopsy for tissue diagnosis is relatively low (usually not exceeding 70%). By contrast, reported accuracy rates for EUS-guided FNA of pancreatobiliary masses are over 80%. This prospective study compared these two modalities for the first time in the diagnosis of indeterminate biliary strictures and pancreatic tumors. METHODS: Fifty consecutive patients (29 men, 21 women; mean age 62.1 years) with obstructive jaundice in whom a tissue diagnosis was required were included. During ERCP, intraductal specimens were obtained with a forceps and with two different types of brush (conventional and spiral suction) in random order. During EUS, only visible mass lesions or localized bile duct wall thickening were aspirated (22-gauge needle), with at least two passes yielding material sufficient for assessment. A cytopathologist was not present in the procedure room to evaluate specimen adequacy. The reference methods were surgery, other biopsy results, follow-up until death, or the conclusion of the study (mean follow-up 20 months). RESULTS: The final diagnoses were malignancy, 28 (16 pancreatic, 12 biliary), and benign biliary stricture, 22. Sensitivity and specificity for ERCP-guided biopsy were 36% and 100%, respectively; for ERCP-guided cytology (when using conventional and spiral suction brushes), 46% and 100%, respectively; and for EUS-guided FNA, 43% and 100%, respectively. If the punctured lesions are considered (n=28) alone, the sensitivity of EUS-guided FNA was 75%. In general, sensitivity was better for ERCP-based techniques in the subgroup biliary tumor (ERCP 75% vs. EUS 25%), whereas EUS-guided biopsy was superior for pancreatic mass (EUS 60% vs. ERCP 38%). CONCLUSIONS: For biliary strictures, combined ERCP- and EUS-guided tissue acquisition seems to be the best approach to tissue diagnosis. From a clinical standpoint, it appears reasonable, when a tissue diagnosis is required, to start with ERCP if biliary malignancy is suspected and with EUS when a pancreatic tumor is thought to be the cause of a biliary stricture.     

Prospective pilot evaluation of a new needle prototype for endoscopic ultrasonography-guided fine-needle aspiration: comparison of cytology and histology yield

OBJECTIVES: Endoscopic ultrasonography (EUS) with the adjunct of EUS-guided fine needle aspiration has become an important diagnostic modality in gastroenterologic oncology. EUS-guided fine needle aspiration mainly relies on cytology; data are scarce that compare cytology and histology. While testing a 22-gauge prototype needle, we prospectively compared the yield for both. METHODS: Forty-two consecutive patients (27 male, 15 female; mean age 59.2 years, range: 17-90 years) were included. In each patient we aimed to make two needle passes, and if the material acquired appeared insufficient macroscopically (no in-room cytopathology was available), further passes were done. The material was sent for cytological and histological assessment. RESULTS: A median number of two passes (range: 2-3) were uneventfully performed for pancreatic lesions (n=30), mediastinal and other lymph nodes/masses (n=8) and various other lesions (n=4) and yielded adequate material for cytology, histology or at least one of the two investigations in 62, 67 and 74% of patients, respectively. No false positive results were found (specificity 100%). Sensitivities were 58.6 and 65.5%, respectively, for cytology and histology alone; combined assessment increased sensitivity to 79.3%. When adjusted values were calculated, based only on those cases with adequate material, sensitivity was 89.5% for cytology and 85.7% for histology, and increased to 100% with combined assessment. CONCLUSION: The new needle achieves sensitivities similar to those previously reported with no significant differences in sensitivity between cytology and histology. More effective tissue acquisition methods must be sought to improve overall results.