超声内镜引导细针穿刺抽吸术在常规内镜活检诊断不明确 的胃肠道病变中的应用价值

目的 评价超声内镜引导细针穿刺抽吸术（EUS-FNA）在常规内镜活检诊断不明确的胃肠道病变中的应用价值。 方法 回顾性分析65例常规内镜活检诊断不明确的胃肠道病变且在我院行EUS-FNA的患者的诊断结果和随访情况，以手术病理和随访结果为最终诊断，评估EUS-FNA对此类病变的诊断价值。结果 本研究中男性患者41例，女性24例，中位年龄60岁。普通内镜下以弥漫浸润型病变最为多见（56.9%），其次为黏膜下隆起型病变（21.7%）。54例（83.1%）患者诊断为肿瘤性病变，非肿瘤性病变11例（83.1%）。EUS-FNA总的诊断敏感度、特异度及准确性为76.8%（95%CI: 65.7%-87.8%）、100%（95%CI: 66.4%-100%）、及80.0%（95%CI: 70.3%-89.7%）。亚组分析显示EUS-FNA在弥漫浸润型病变中的诊断敏感度、特异度及准确性分别为70.6%（95%CI: 55.3%-85.9%）、100%（95%CI: 29.2%-100%）及73.0%（95%CI: 58.7%-87.3%）;在黏膜下隆起型病变中的诊断敏感度、特异度及准确性分别为68.8%（95%CI: 46.0%-91.5%）、100%（95%CI: 2.5%-100%）及70.6%（95%CI: 44.0%-89.7%）。结论 EUS-FNA对常规内镜活检诊断不明确的胃肠道病变具有中等强度的诊断价值，可作为此类病变在常规内镜活检无法确诊后的备选方案，但仍需结合其他手段或技术改进以进一步提高EUS-FNA的诊断效能。

Endoscopic ultrasound-guided fine needle aspiration in the diagnosis of gastrointestinal lesions with inconclusive endoscopic biopsies

Objective The purpose was to determine the diagnostic yield of Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in evaluating gastrointestinal lesions with inconclusive endoscopic biopsies. Methods A retrospective analysis was performed in 65 patients who were found to have gastrointestinal lesions with inconclusive endoscopic biopsies and underwent EUS-FNA in our hospital. Compared with surgical histopathology and follow-up status, the utility of EUS-FNA in evaluating such lesions was investigated. Results This study included 41 males (63%) and 24 females (37%) with a median age of 60.0 years. The most common endoscopic appearances were diffuse infiltrative lesions (56.9%), followed by submucosal protrusion types (26.2%). Fifty-four cases (83.1%) were shown to have malignant lesions, and 11 cases (21.7%) were shown to be benign. The overall sensitivity, specificity, and accuracy of EUS-FNA for gastrointestinal lesions with inconclusive biopsies were 76.8% (95%CI: 65.7%-87.8%), 100% (95%CI: 66.4%-100%), and 80.0% (95%CI: 70.3%-89.7%), respectively. For diffuse infiltrative lesions, the sensitivity, specificity, and accuracy of EUS-FNA was 70.6% (95%CI: 55.3%-85.9%, 100% (95%CI: 29.2%-100%), and 73.0% (95%CI: 58.7%-87.3%), respectively. For submucosal protrusions, the sensitivity, specificity, and accuracy of EUS-FNA was 68.8% (95%CI: 46.0%-91.5%), 100% (95%CI: 2.5%-100%), and 73.0% (95%CI: 44.0%-89.7%), respectively. Conclusion EUS-FNA had a moderate diagnostic value in diagnosing endoscopic biopsy-inconclusive gastrointestinal lesions. It can be an alternative option when standard methods, such as endoscopic mucosal forceps biopsy, failed to provide a definitive diagnosis. Complementary techniques and additional refinements in EUS-FNA may enhance its diagnostic efficiency in such lesions.