超声内镜引导下胰腺穿刺活检的现状

内镜超声检查术(endoscopic ultrasonography,EUS)是近10 a来开展的新技术,目前已广泛应用于上消化道及邻近脏器疾病的诊断.EUS引导下穿刺活检是EUS的重大进展.现就EUS引导下穿刺活检对胰腺疾病.尤其是胰腺肿瘤的诊断价值作一综述.1胰腺的穿刺活检方法自1972Oscarson首创的血管造影下经皮胰腺活检以及Smith et al行B超引导下经皮胰腺活检以来,胰腺疾病的细胞学和组织学诊断技术发展迅速,目前胰腺疾病的穿刺活检方法主要有:①术中直视下胰腺穿刺活检;②B超、CT及经内镜逆行胰管造影术(endoscopic retrograde pancreatography,ERP)引导下经皮细针穿刺活检;③超声内镜引导下细针穿刺活检(endoscopic ultrasound guided fine needle aspiration biopsy.EUS     

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…     

胰腺囊性占位的影像学诊断比较研究

目的比较EUS、CT、ERCP、MRCP对胰腺囊性占位的诊断. 方法对46例胰腺囊性占位患者行EUS检查,并同时行CT、ERCP、MRCP、体表超声等检查,并对9例患者行EUS(B超)引导下胰腺囊性占位细针穿刺活检术.     

超声内镜在胰腺肿瘤治疗中的应用进展

超声内镜( endoscopic ultrasonography,EUS)应用于临床已有30多年,早期EUS仅作为一种诊断方法应用于临床.随着凸面线阵型内镜超声的诞生,以超声内镜引导下细针穿刺为基础的诊断和治疗技术也逐渐发展起来.EUS引导下细针穿刺活检(EUS guided fine - needle aspiration,EUS - FNA)在诊断方面的应用已取得重大进展.     

内镜超声引导下乙醇注射治疗在胰腺肿瘤中的应用进展

随着内镜超声(EUS)技术的发展,EUS在疾病治疗方面得到了广泛应用,特别是EUS引导下细针注射治疗(EUSguided fine needle injection,EUS-FNI)逐渐引起了人们的重视.EUS-FNI是在细针穿刺(fine needle aspiration,FNA)的基础上,将药物或免疫制剂通过穿刺针对病灶进行局部注射,从而达到治疗目的的介入治疗技术,特别是在胰腺肿瘤治疗方面有其独特的优势,如EUS引导下近距离放射治疗、注射抗肿瘤病毒载体等已应用于临床.近年来也有文献报道EUS引导下给予乙醇注射治疗胰腺肿瘤,现就EUS引导下乙醇注射治疗在胰腺肿瘤的应用进展作一综述.     

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.     

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。     

内镜超声引导下细针注射治疗法在胰腺肿瘤中的应用进展

内镜超声(endoscopic ultrasonography,EUS)应用于临床已有30多年[1-2].早期EUS仅作为一种诊断方法,随着内镜超声技术的发展及线阵超声扫描探头的应用,EUS引导下细针穿刺活检(EUS guided fine-needle aspiration,EUS-FNA)在临床应用取得重大进展.     

超声内镜引导下细针穿刺活检在胰腺肿瘤诊断中的价值

超声内镜引导下细针穿刺活检(endoscopic ultrasoundguided fine needle aspiration biopsy,EUS-FNAB)是在EUS的基础上获得细胞学诊断,故扩展了EUS的应用。自从1992年Vilmann首先成功报道对胰腺的EUS-FNAB后,其在胰     

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。     

Predictors of malignancy and recommended follow-up for patients with negative endoscopic ultrasound-guided fine-needle aspiration of suspected pancreatic lesions

BACKGROUND:

Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) can characterize and diagnose pancreatic lesions as malignant, but cannot definitively rule out the presence of malignancy. Outcome data regarding the length of follow-up in patients with negative or nondiagnostic EUS-FNA of pancreatic lesions are not well-established.

OBJECTIVE:

To determine the long-term outcome and provide follow-up guidance for patients with negative EUS-FNA diagnosis of suspected pancreatic lesions based on imaging predictors.

METHODS:

A retrospective review of patients undergoing EUS-FNA for suspected pancreatic lesions, but with negative or nondiagnostic FNA results was conducted at a tertiary care referral medical centre. Patient demographics, EUS imaging characteristics and follow-up data were examined.

RESULTS:

Seventeen of 55 patients (30.9%) with negative/nondiagnostic FNA were subsequently diagnosed with pancreatic malignancy. The risk of cancer was significantly higher for patients who had associated lymph nodes on EUS (P<0.001) and vascular involvement on EUS (P=0.001). The mean time to diagnosis in the group with false-negative EUS-FNA diagnosis was 66 days. The true-negative EUS-FNA patients were followed for a mean of 403 days after negative EUS-FNA results without the development of malignancy.

CONCLUSION:

For patients undergoing EUS-FNA for a suspected pancreatic lesion, a negative or nondiagnostic FNA does not provide conclusive evidence for the absence of cancer. Patients for whom vascular invasion and lymphadenopathy are detected on EUS are more likely to have a true malignant lesion and should be followed closely. When a patient has been monitored for six months or more with no cancer being diagnosed, there appears to be much less chance that a pancreatic malignancy is present.     

Possibilities of interventional endoscopic ultrasound

Since endoscopic ultrasound (EUS) was developed in the 1990s, EUS has become widely accepted as an imaging tool. EUS is categorized into radial and linear in design. Radial endoscopes provide cross-sectional imaging of the mediastinum, gastrointestinal tract, liver, spleen, kidney, adrenal gland, and pancreas, which has highly accuracy in the T and N staging of esophageal, lung, gastric, rectal, and pancreatic cancer. Tumor staging is common indication of radial-EUS, and EUSstaging is predictive of surgical resectability. In contrast, linear array endoscope uses a side-viewing probe and has advantages in the ability to perform EUSguides fine needle aspiration (EUS-FNA), which has been established for cytologic diagnosis. For example, EUS-FNA arrows accurate nodal staging of esophageal cancer before surgery, which provides more accurate assessment of nodes than radial-EUS imaging alone. EUS-FNA has been also commonly used for diagnose of pancreatic diseases because of the highly accuracy than US or computed tomography. EUS and EUS-FNA has been used not only for TNM staging and cytologic diagnosis of pancreatic cancer, but also for evaluation of chronic pancreatitis, pancreatic cystic lesions, and other pancreatic masses. More recently, EUS-FNA has developed into EUS-guided fine needle injection including EUS-guided celiac plexus neurolysis, celiac plexus block, and other "interventional EUS" procedures. In this review, we have summarized the new possibilities offered by "interventional EUS".     

Simultaneous endoscopic ultrasound fine needle aspiration and endoscopic retrograde cholangio-pancreatography： Evaluation of safety

AIM： To investigate the rate of complications of endoscopic retrograde cholangio-pancreatography （ERCP） performed immediately after endoscopic ultrasound fine needle aspiration （EUS-FNA） in a large series of patients.
METHODS： Patients with the following conditions were considered candidates for EUS-FNA and ERCP： diagnosis of locally advanced or metastatic pancreatic lesion not eligible for surgery, and patients with pancreatic lesion of unknown nature causing jaundice. Data were prospectively collected on the following parameters： indication for FNA, EUS findings, pathological diagnosis, procedure duration of EUS-FNA and combined EUS-FNA and ERCP, and immediate and late complications.
RESULTS： From January 2004 to October 2006, 72 patients were deemed eligible for combined EUS and ERCP. In 25/72 EUS-FNA was performed to obtain a pathology diagnosis of lesions causing biliary obstruction, and ERCP sequentially performed to drain the biliary system. No immediate complications occurred except for two mild bleeding episodes post sphincterotomy. No late complications were recorded except for one patient who experienced fever, promptly recovered with antibiotic therapy.
CONCLUSION： Simultaneous approach appears to be feasible and safe. When possible, this can be considered the reference standard to avoid double sedation and reduce duration of the procedure and hospital stay.     

Three-dimensional linear endoscopic ultrasound-feasibility of a novel technique applied for the detection of vessel involvement of pancreatic masses

BACKGROUND: Endoscopic ultrasound (EUS) can reliably diagnose and stage pancreatic cancer but is less competent for the differentiation between vascular compression (VC) and invasion (VI). AIM: Prospective comparison of linear EUS with/without three-dimensional (3D) EUS for vessel involvement in pancreatic cancer to evaluate the feasibility of linear 3D ultrasound. MATERIAL AND METHODS: Linear echoendoscopy was used to identify the pancreatic tumor, the tumor-vessel relation and for EUS-FNA to obtain tissue diagnosis. Immediately afterwards, 3D image acquisition was performed using a magnetic tracked 3D sensor. The acquisition time was 10-20 s. RESULTS: EUS results of 22 patients with solid pancreatic lesions were compared to surgical histology. This proved adenocarcinoma in 17 patients and chronic pancreatitis in 5. EUS showed VI in 10 patients, VC in 6, and no vascular involvement (NVI) in 6. Additional 3D evaluation showed VI in 6 patients, VC in 10, and NVI in 6. Surgery proved VI in 7 patients, VC in 9, and NVI in 6. EUS showed VI in 3/5 patients with chronic pancreatitis, 3D showed VC only, while surgery found two patients to have VC and with NVI. In two patients with pancreatic cancer, VI was diagnosed on two dimensional (2D), but VC on 3D evaluation. Surgery showed VC and VI in one each. In the 2D, one patient with NVI had VI on surgery; and on 3D one VC proved to have NVI at surgery. In 1/22 patients the result of 3D was false negative, while 4/22 were false positives and one false negative in conventional EUS. CONCLUSION: Linear 3D EUS seems feasible for pancreatic evaluation. In addition, linear EUS enhanced the evaluation of vascular involvement of pancreatic lesions, especially in chronic pancreatitis.     

Interventional endoscopic ultrasound: Therapeutic capability and potential

The linear echoendoscope, introduced in the 1990s, opened the era of interventional endoscopic ultrasound (IEUS). The linear echoendoscope enabled EUS guided Fine Needle Aspiration (EUS-FNA) allowing the path of the needle to be traced during the puncture process. After EUS-FNA, other interventional procedures were introduced in clinical practice. Tissue acquisition was the first EUS-guided interventional procedure and its higher diagnostic quality has undoubtedly been established. After EUS-FNA, Celiac plexus neurolysis (CPN) and block (CPB), pancreatic pseudocyst drainage, abdominal and mediastinal collections/abscesses drainage, and in selected cases, pancreatic and biliary ductal system drainage, were introduced in clinical practice. EUS-guided fine needle injection with local delivery of antitumor agents is considered a promising modality. We have reviewed published data on EUS guided interventional procedures with the object of summarizing the diagnostic capability of endoscopic ultrasound and elaborates in detail its therapeutic capability and potential.     

Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer

INTRODUCTION: Endoscopic ultrasound (EUS) is now established as a valuable imaging test for diagnosing and staging pancreatic cancer. But, with significant recent improvements in spiral CT scanners, particularly higher resolution and ability to reconstruct 3D images, spiral CT is now increasingly accepted as being better for pancreatic cancer staging. The debate continues, however, about the best diagnostic test or combination of tests in patients with suspected pancreatic cancer. Spiral CT is more readily available than EUS-FNA and, therefore, more frequently used. In this study, we evaluated the use of EUS-FNA in conjunction with spiral CT for suspected pancreatic cancer. METHODS: We retrospectively evaluated 81 consecutive patients who underwent EUS and EUS-FNA for clinical suspicion of a pancreatic cancer from November 2000 to November 2001. All patients had spiral CT with a multiphasic pancreatic protocol using multidetector spiral CT scanners. In all patients, EUS-FNA and spiral CT examinations were performed less than 3 wk apart. RESULTS: Overall, the accuracy of spiral CT, EUS, and EUS-FNA was 74% (n = 60/81, CI 63-83%), 94% (n = 76/81, CI 87-98%), and 88% (n = 73/81, CI 81-96%), respectively, for diagnosing pancreatic cancer. In patients without an identifiable mass on spiral CT, the diagnostic accuracy of EUS and EUS-FNA for pancreatic tumors was 92% (n = 23/25, CI 74-99%). Absence of a focal "mass" lesion on EUS reliably excluded pancreatic cancer irrespective of clinical presentation (NPV 100% n = 5/5, CI 48-100%). The negative predictive value of EUS-FNA was only 22% (n = 2/9, CI 3-60%) in patients with obstructive jaundice and biliary stricture. However, in patients without obstructive jaundice at initial presentation, EUS-FNA was highly accurate (accuracy 97%, n = 33/34, CI 85-100%) and was reliable for ruling out malignancy (NPV 89%, n = 8/9, CI 52-100%). Cytologic assessment of EUS-FNA specimens was 89% accurate for identifying malignancy in suspicious lesions visualized on EUS. CONCLUSIONS: The EUS with FNA can be a valuable adjunct to newer high-resolution multidetector spiral CT for diagnostic evaluation of patients with suspected pancreatic cancer.     

Percutaneous ultrasound and endoscopic ultrasound-guided biopsy of solid pancreatic lesions: An analysis of 1074 lesions

Backgrounds: Percutaneous ultrasound (US) and endoscopic ultrasound (EUS)-guided pancreatic biopsies are widely accepted in the diagnosis of pancreatic diseases. Studies comparing the diagnostic performance of US- and EUS-guided pancreatic biopsies are lacking. This study aimed to evaluate and compare the diagnostic yields of US- and EUS-guided pancreatic biopsies and identify the risk factors for inconclusive biopsies. Methods: Of the 1074 solid pancreatic lesions diagnosed from January 2017 to February 2021 in our center, 275 underwent EUS-guided fine needle aspiration (EUS-FNA), and 799 underwent US-guided core needle biopsy (US-CNB/FNA). The outcomes were inconclusive pathological biopsy, diagnostic accuracy and the need for repeat biopsy. All of the included factors and diagnostic performances of both US-CNB/FNA and EUS-FNA were compared, and the independent predictors for the study outcomes were identified. Results: The diagnostic accuracy was 89.8% for EUS-FNA and 95.2% for US-CNB/FNA ( P = 0.001). Biopsy under EUS guidance [odds ratio (OR) = 1.808, 95% confidence interval (CI): 1.083-3.019; P = 0.024], lesion size < 2 cm (OR = 2.069, 95% CI: 1.145-3.737; P = 0.016), hypoechoic appearance (OR = 0.274, 95% CI: 0.097-0.775; P = 0.015) and non-pancreatic ductal adenocarcinoma carcinoma (PDAC) diagnosis (OR = 2.637, 95% CI: 1.563-4.449; P < 0.001) were identified as factors associated with inconclusive pathological biopsy. Hypoechoic appearance (OR = 0.236, 95% CI: 0.064-0.869; P = 0.030), lesions in the uncinate process of the pancreas (OR = 3.506, 95% CI: 1.831-6.713; P < 0.001) and non-PDAC diagnosis (OR = 2.622, 95% CI: 1.278-5.377; P = 0.009) were independent predictors for repeat biopsy. Biopsy under EUS guidance (OR = 2.024, 95% CI: 1.195-3.429; P = 0.009), lesions in the uncinate process of the pancreas (OR = 1.776, 95% CI: 1.014-3.108; P = 0.044) and hypoechoic appearance (OR = 0.127, 95% CI: 0.047-0.347; P < 0.001) were associated with diagnostic accuracy. Conclusions: Both percutaneous US- and EUS-guided biopsies of solid pancreatic lesions are safe and effective; though the diagnostic accuracy of EUS-FNA is inferior to US-CNB/FNA. A tailored pancreatic biopsy should be considered a part of the management algorithm for the diagnosis of solid pancreatic disease.     

Efficacy of endoscopic ultrasonography and endoscopic ultrasonography-guided fine-needle aspiration for the diagnosis and grading of pancreatic neuroendocrine tumors

Background and aim: Pancreatic neuroendocrine tumors (pNETs) are histologically categorized according to the WHO 2010 classification by their mitotic index or Ki-67 index as G1, G2, or G3. The present study examined the efficacy of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) in the diagnosis and grading of pNET. Methods: We retrospectively reviewed 61 pNETs in 51 patients who underwent EUS between January 2007 and June 2014. All lesions were pathologically diagnosed by surgical resection or EUS-FNA. We evaluated the detection rates of EUS for pNET and sensitivity of EUS-FNA, and compared the Ki-67 index between EUS-FNA samples and surgical specimens. EUS findings were compared between G1 and G2/G3 tumors. Results: EUS showed significantly higher sensitivity (96.7%) for identifying pNET than CT (85.2%), MRI (70.2%), and ultrasonography (75.5%). The sensitivity of EUS-FNA for the diagnosis of pNET was 89.2%. The concordance rate of WHO classification between EUS-FNA and surgical specimens was 69.2% (9/13). The concordance rate was relatively high (87.5%, 5/6) in tumors?<20?mm but lower (57.1%; 4/7) in tumors?≥20?mm. Regarding EUS findings, G2/G3 tumors were more likely to be large (>20?mm), heterogeneous, and have main pancreatic duct (MPD) obstruction than G1 tumors. Multivariate analysis showed large diameter and MPD obstruction were significantly associated with G2/G3 tumors. Conclusions: EUS and EUS-FNA are highly sensitive and accurate diagnostic methods for pNET. Characteristic EUS findings such as large tumor size and MPD obstruction are suggestive of G2/G3 tumors and would be helpful for grading pNETs.     

Sensitivity of CT,MRI, and EUS-FNA/B in the preoperative workup of histologically proven left-sided pancreatic lesions

Background and objectivesLeft-sided pancreatic lesions are often treated surgically. Accurate diagnostic work-up is therefore essential to prevent futile major abdominal surgery. Large series focusing specifically on the preoperative work-up of left-sided pancreatic lesions are lacking. This surgical cohort analysis describes the sensitivity of CT, MRI, and EUS-FNA/B in the diagnostic work-up of left-sided pancreatic lesions.MethodsWe performed a post-hoc analysis of patients who underwent surgery for a left-sided pancreatic lesion between April 2010 and August 2017 and participated in the randomized CPR trial. Primary outcome was the sensitivity of CT, MRI, and EUS-FNA/B. Sensitivity was determined as the most likely diagnosis of each modality compared with the postoperative histopathological diagnosis. Additionally, the change in sensitivity of EUS versus EUS-FNA/B (i.e., cyst fluid analysis, and/or tissue acquisition) was measured.ResultsOverall, 181 patients were included (benign: 23%, premalignant: 27%, malignant: 50%). Most patients had solid lesions (65%). Preoperative imaging included CT (86%), MRI (41%), EUS (68%). Overall, CT and EUS-FNA/B reached a sensitivity of both 71%, compared with 66% for MRI. When EUS was combined with FNA/B, sensitivity rose from 64% to 71%. For solid lesions, CT reached the highest sensitivity (75%) when compared with MRI (70%) and EUS-FNA/B (69%). For cystic lesions, EUS-FNA/B reached the highest sensitivity (75%) when compared with CT and MRI (both 62%).ConclusionsCT is the most sensitive diagnostic modality for solid and EUS-FNA/B for cystic left-sided pancreatic lesions. EUS-FNA/B was associated with an increased sensitivity when compared to EUS alone.     

Applications of endoscopic ultrasound in pancreatic cancer

Since the introduction of endoscopic ultrasound guided fine-needle aspiration(EUS-FNA),EUS has assumed a growing role in the diagnosis and management of pancreatic ductal adenocarcinoma(PDAC).The objective of this review is to discuss the various applications of EUS and EUS-FNA in PDAC.Initially,its use for detection,diagnosis and staging will be described.EUS and EUS-FNA are highly accurate modalities for detection and diagnosis of PDAC,this high accuracy,however,is decreased in specific situations particularly in the presence of chronic pancreatitis.Novel techniques such as contrast-enhanced EUS,elastography and analysis of DNA markers such as k-ras mutation analysis in FNA samples are in progress and might improve the accuracy of EUS in the detection of PDAC in this setting and will be addressed.EUS and EUS-FNA have recently evolved from a diagnostic to a therapeutic technique in the management of PDAC.Significant developments in therapeutic EUS have occurred including advances in celiac plexus interventions with direct injection of ganglia and improved pain control,EUS-guided fiducial and brachytherapy seed placement,fine-needle injection of intra-tumoral agents and advances in EUS-guided biliary drainage.The future role of EUS and EUS in management of PDAC is still emerging.