内镜超声引导下细针穿刺细胞学及囊液癌胚抗原分析诊断胰腺囊性病变的价值

目的探讨内镜超声引导下细针穿刺（EUS-FNA）细胞学检查、囊液癌胚抗原（cEA）分析对区分胰腺囊性病变良恶性的诊断价值。方法对27例胰腺囊性病变患者行EUS-FNA细胞学检查和囊液CEA分析，绘制囊液CEA受试者工作特征曲线并通过Youden指数确定诊断临界值，以手术病理诊断为金标准，统计分析EUS、EUS-FNA细胞学及囊液CEA分析鉴别诊断胰腺囊性病变良恶性的敏感度、特异度、阳性预测值、阴性预测值和准确率。结果手术病理确诊良性病变14例、潜在恶性／恶性病变13例。EUS鉴别诊断胰腺囊性病变良恶性的准确率、敏感度、特异度、阳性预测值、阴性预测值分别为77．8％（21／27）、69．2％（9／13）、85．7％（12／14）、81．8％（9／11）、75．0％（12／16）；EUS-FNA细胞学上述指标分别为85．2％（23／27）、76．9％（10／13）、92．9％（13／14）、90．9％（10／11）、81．3％（13／16）；以囊液CEA值22．24ng／ml为诊断临界值，上述指标分别为74．1％（20／27）、84．6％（11／13）、64．3％（9／14）、68．8％（11／16）、81．8％（9／11）。结论EUS-FNA细胞学鉴别诊断胰腺囊性病变良恶性具有较高的准确率和特异度，而囊液CEA分析（诊断临界值22．24ng／m1）鉴别诊断胰腺囊性病变良恶性的敏感度较高，选择合适的胰腺囊液CEA分析诊断临界值结合EUS-FNA细胞学检查可以基本满足临床鉴别胰腺囊性病变良恶性的需要。

Value of EUS-FNA cytology and fluid carcinoembryonic antigen in differential diagnosis between be-nigh or malignant pancreatic cystic lesion

Objective To study the value of EUS-FNA cytology and fluid carcinoembryonic antigen （CEA） for differential diagnosis of malignant and benign pancreatic cystic lesions. Methods Data of 27 patients who underwent EUS-FNA were reviewed. According to Youden exponent, the optimal cut-off points for cyst fluid CEA were determined by receiver operating characteristic （ROC） curve. Compared with surgical pathology, the accuracy, sensitivity, specificity, positive predictive value （PPV） and negative pre- dictive value （NPV） of the EUS imaging, cytology as well as cyst fluid CEA were determined. Results Of the 27 cases, 14 were diagnosed as benign lesions, 13 were diagnosed as malignant or premalignant lesions. The accuracy , sensitivity, specificity, PPV and NPV of EUS imaging were 77. 8% （ 21/27 ）, 69. 2% （9/13）, 85.7% （ 12/14）, 81.8% （9/11） and 75.0% （12/16）. The accuracy , sensitivity, specificity, PPV and NPV of EUS-FNA cytology were 85.2% （23/27）, 76. 9% （10/13）, 92.9% （13/14）, 90. 9% （ 10/11 ）, and 81.3% （13/16）. The corresponding values of fluid carcinoembryonic antigen under the ROC- derived ideal cut-off were 74. 1% （20/27）, 84. 6% （11/13）, 64. 3% （9/14）, 68.8% （11/16） and 81.8% （9/11） （CEA 〉 22. 24 ng/ml）. Conclusion EUS-FNA cytology is highly accurate and specific for differential diagnosis of malignant and benign pancreatic cystic lesions. Cyst fluid CEA shows better sensitivi-ty. EUS-FNA cytology and cyst fluid CEA analysis can basically meet the requirement of differentiating the benign and （pre）malignant pancreatic cystic lesions.