超声内镜细针穿刺术对非上消化道黏膜下肿物的诊断价值及误诊分析

目的探讨超声内镜(EUS)引导下细针穿刺术(EUS-FNA)对EUS误诊的非上消化道黏膜下肿物(SMT)病变的诊断价值,分析误诊原因。方法回顾性分析在我院就诊,并经常规胃镜初筛和EUS诊断为SMT,最后通过EUS-FNA取得病理组织确诊为非SMT的15例患者,比较EUS特征和最终诊断,分析误诊原因。结果15例患者中肺腺癌2例、肺鳞癌2例、小细胞癌2例、恶性淋巴瘤1例、炎性团块1例、非特异度淋巴结炎2例、巨淋巴结增生病(Castleman病)1例、结核4例。所有患者均成功实施EUS-FNA并获取满意病理学标本,未发生穿孔及出血等并发症。结论EUS下某些病变内部回声不均匀、上消化道层次不清晰、周围结构显示不清,易导致误诊,EUS-FNA能安全有效地鉴别肿物性质,从而避免误诊,指导治疗,具有较好的临床应用价值。

Diagnostic Value and Misdiagnosis Analysis of Non-upper Gastrointestinal Submucosal Mass With Endoscopic Ultrasonography Fine Needle Aspiration

Objective To investigate the value of endoscopic ultrasonography guided fine needle aspiration(EUS-FNA)in leisions misdiagnosed as submucousal tumors(SMT)by EUS and to analyze the misdiagnosis.Methods A retrospective analysis was performed on 15 patients during firstly diagnosed as SMT by conventional endoscopy microsurgery and EUS and finally diagnosed as non-SMT by EUS-FNA.Moreover,the EUS results and final diagnosis were compared,and the cause of misdiagnosis was summarized.Results Among the 15 cases,2 cases were lung adenocarcinoma,2 cases were lung squamous cell carcinoma,2 cases were small cell carcinoma,1 case was malignant lymphoma,1 case was inflammatory mass,2 cases were non-specific lymphadenitis,4 cases were tuberculosis,and 1 case was Castleman disease.EUS-FNA was successfully implemented and satisfactory pathological specimens were obtained in all cases,and no complication including bleeding and perforation happened.Conclusions The uneven internal echo,unclear upper gastrointestinal wall,and unclear surrounding structures of lesions may lead to misdiagnosis by EUS.EUS-FNA can safely and effectively diagnose the masses,avoid misdiagnosis and guide clinical treatment,thus has good clinical application value.