超声内镜引导细针穿刺检测端粒酶活性:辅助诊断胰腺癌  

Determination of qualitative telomerase activity as an adjunct to the diagnosis of pancreatic adenocarcinoma by EUS-guided fine-needle aspiration

作　　者：Mishra G. Sweeney J. 成虹 

机构地区：[1]Department of Internal Medicine,Section of Gastroenterology,Wake Forest University School of Medicine,Winston-Salem,NC,United States Dr.

出　　处：《世界核心医学期刊文摘（胃肠病学分册）》2006年第9期35-36,共2页Core Journals in Gastroenterology

摘　　要：Background:Telomerase activity is up-regulated in pancreatic cancer.Hence,measurement of telomerase activity in pancreatic needle-biopsy specimens could assist in establishing a positive diagnosis in specimens that are inadequate for cytology.Objective:To determine the sensitivity and specificity of telomerase activity for neoplasia in a series of EUS-guided fine-needle aspirate(EUS-FNA)biopsies of pancreatic mass lesions.Design:Prospective,consecutive,nonrandomized cohort.Setting:Academic hospital,tertiary referral center.Patients:Seventy-one patients with a pancreatic mass diagnosed by cross-sectional imaging.Interventions:EUS-FNA of 52 solid and 18 cystic pancreatic lesions.Main Outcome Measurements:(1)Cytologic diagnosis;(2)tissue telomerase activity by semi-quantitative polymerase chain reaction;(3)patient demographics;(4)clinical outcomes.Results:Cytology results were positive for adenocarcinoma in 40 patients with a solid pancreatic mass;of these,telomerase activity was detected in 31.There were no telomerase false-positive results.Telomerase results were positive in 6 of the 7 patients(86%)who had negative cytology results and who eventually were found to have biopsy-proven adenocarcinoma.The sensitivity and specificity of telomerase activity for detecting pancreatic adenocarcinoma in solid masses was 79%(95%CI,64%-89%)and 100%(95%CI,55%-100%).Limitations:Extremely high sensitivity and specificity of EUS-FNA cytology in solid lesions minimized the incremental benefit of telomerase.Conclusions:Telomerase activity can be measured readily in specimens obtained at EUS-FNA and accurately predicts malignancy.Used in combination with cytology,telomerase increased the sensitivity from 85%to 98%while maintaining the specificity at 100%.Lesions with negative cytology result and positive telomerase activity should be evaluated aggressively to exclude malignancy.Background： Telomerase activity is up-regulated in pancreatic cancer. Hence, measurement of telomerase activity in pancreatic needle-biopsy specimens could assist in establishing a positive diagnosis in specimens that are inadequate for cytology. Objective： To determine the sensitivity and specificity of telomerase activity for neoplasia in a series of EUS-guided fine-needle aspirate （EUS-FNA） biopsies of pancreatic mass lesions. Design： Prospective, consecutive, non-randomized cohort. Setting： Academic hospital, tertiary referral center. Patients： Seventy-one patients with a pancreatic mass diagnosed by cross-sectional imaging. Interventions： EUS-FNA of 52 solid and 18 cystic pancreatic lesions. Main Outcome Measurements： （1） Cytologic diagnosis; （2） tissue telomerase activity by semiquantitative polymerase chain reaction; （3） patient demographics; （4）clinical outcomes. Results： Cytology results were positive for adenocarcinoma in 40 patients with a solid pancreatic mass; of these, telomerase activity was detected in 31. There were no telomerase false-positive results. Telomerase results were positive in 6 of the 7 patients （86%） who had negative cytology results and who eventually were found to have biopsy-proven adenocarcinoma. The sensitivity and specificity of telomerase activity for detecting pancreatic adenocarcinoma in solid masses was 79% （95% CI, 64% -89%） and 100% （95% CI, 55% -100% ）. Limitations： Extremely high sensitivity and specificity of EUS-FNA cytology in solid lesions minimized the ：incremental benefit of telomerase. Conclusions： Telomerase activity can be measured readily in specimens obtained at EUS-FNA and accurately predicts malignancy. Used in combination with cytology,

关 键 词：组织端粒酶活性 胰腺癌患者 超声内镜引导 检测标本 辅助诊断 细针穿刺 实质占位性病变 胰腺占位性病变 

分 类 号：R735.202[医药卫生—肿瘤]