超声内镜引导下细针抽吸活检对胰腺实质病变的诊断价值  

Value of endoscopic ultrasonography guided fine needle aspiration in diagnosis of pancreatic neoplasms

作　　者：吴巍[1] 诸琦[1] 夏璐[1] 谭继宏[1] 陈希[1] 熊慧芳[1] 叶廷军[2] 袁琴[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院消化内科,上海200025 [2]上海交通大学医学院附属瑞金医院检验科细胞室,上海200025

出　　处：《诊断学理论与实践》2008年第6期617-620,共4页Journal of Diagnostics Concepts & Practice

摘　　要：目的:探讨超声内镜引导下细针抽吸活检(EUS-FNA)诊断胰腺实质性肿块的准确度及其临床应用价值。方法:连续收集因胰腺实质性肿块于本院消化科行EUS-FNA的患者,对其病灶、大小、穿刺负压、穿刺次数、细胞学诊断及临床最终诊断进行分析。结果:44例患者均成功施行EUS-FNA,共行65次穿刺,其中50%的病变位于胰头/钩突部,病灶大小平均为35mm×29mm。EUS-FNA对44例胰腺实质性占位性病变的诊断准确度为81.8%(36/44),其中28例患者获得明确细胞学恶性肿瘤依据。长径>3cm的胰腺肿块恶性比例显著上升(P=0.019),而肿瘤短径、部位、穿刺负压与恶性肿瘤诊断率无关。实时细胞病理诊断可有效提高FNA对胰腺肿块的诊断准确度(P=0.010),并显著减少穿刺次数(P=0.020)。所有患者均未发生操作相关并发症。结论:EUS-FNA可有效诊断胰腺实质性肿块的良恶性,是一项安全性好、特异度高的诊断手段,在胰腺肿瘤的细胞病理诊断中具有重要临床价值。Objective To investigate the diagnostic value and clinical application of endoscopic ultrasonographyguided fine needle aspiration （EUS-FNA） in patients with pancreatic mass. Methods Patients with a clinical diagnosis of pancreatic mass undergone EUS-FNA between Jul. 2006 and Feb. 2008 in Shanghai Ruijin Hospital were reviewed. The site and dimension of lesion, number of aspiration, negative pressure at each aspiration, cytological diagnosis and final diagnosis were analyzed. Results All 44 consecutive patients underwent EUS-FNA without procedure-related complications. The mean mass dimension was 35 mm±29 mm, with 50% located in the head of the pancreas. A total of 65 aspirations were performed. The overall diagnostic accuracy was 81.8% （36/44）, while malignancy was verified cytologically in 28 patients. The risk of malignancy increased markedly in lesions with a longitudinal axis longer than 3 cm （P=-0.019）, whereas the site, short-axis diameter and negative pressure at aspiration had no correlation with the diagnostic rate of malignancy. Real time cytological diagnosis could markedly improve the diagnostic accuracy （P=0.010） and decreased the number of passes （P=-0.020）. Conclusions EUS-FNA can differentiate benign from malignant pancreatic masses, and is a safe modality with high specificity for the cytological diagnosis of pancreatic tumor.

关 键 词：内镜超声检查 细针抽吸术 诊断 

分 类 号：R445[医药卫生—影像医学与核医学]