超声内镜弹性成像与细针抽吸术在病变良恶性判断中的应用价值  

Role of EUS elastography and EUS-FNA for differential diagnosis between malignant and benign disease

作　　者：徐凯[1] 徐萍[1] 任大宾[1] 李清华[1] 杨静[1] 于海滨[1] 

机构地区：[1]上海交通大学附属第一人民医院松江分院消化疾病临床诊治中心,上海市201600

出　　处：《中国内镜杂志》2013年第12期1251-1256,共6页China Journal of Endoscopy

基　　金：上海市科委医学引导类科技项目(114119b0100);上海市卫生局青年科研项目(2009Y135);上海市松江区科学技术攻关项目(2011SJGG22)

摘　　要：目的探讨超声内镜弹性成像和超声内镜细针穿刺抽吸术（EUS-FNA）对消化道及周围病变良恶性判断的临床应用价值。方法 2009年11月~2012年6月,对21例胰腺及其他消化道以及周围病变患者行超声内镜弹性成像及EUS-FNA以判断病变良恶性,病变位于胰腺11例（头部7例、体部2例、尾部2例）、后腹膜5例、胃壁3例、纵膈和食管各1例。超声内镜弹性成像评分为1、2分的病变判断为良性病变,3~5分为恶性病变。EUS-FNA穿刺抽吸标本以发现癌细胞或异型细胞为阳性（恶性病变）,未见肿瘤细胞或符合良性肿瘤细胞为阴性（良性病变）。结果依据超声内镜弹性成像判断标准,超声内镜弹性成像对所有的病变的良恶性均做出了准确的判断;依据细胞病理学检查结果,EUS-FNA对18例患者病变的良恶性做出了准确的判断,3例胰腺癌患者穿刺未发现肿瘤细胞而误判为良性;此外,依据EUS-FNA细胞病理学检查对14例患者病变的具体性质做出了准确的判断。结论超声内镜弹性成像作为一种新的影像学手段,有着无创、操作简便、准确性高等优点,虽并不能完全代替EUS-FNA的细胞病理学诊断,但对于一些无法行EUS-FNA或反复行EUS-FNA均为阴性的可疑病变,超声内镜弹性成像可提供具有重要价值的影像学依据。【Objective】To investigate the usefulness of EUS elastography and endoscopic ultrasound guided fine needle aspiration（EUS-FNA） for the differential diagnosis of malignant and benign disease in upper digestive tract and its peripheral areas.【Methods】Between September 2009 and June 2012, a total of 21 Patients who underwent EUS elastography and EUS-FNA for occupying lesions in upper digestive tract were enrolled. The locations of lesions were pancreas（11 cases）, retroperitoneal（5 cases）, gastric wall（3 cases）, Mediastinal（1 case） and esophagus（1case）. Elastographic pattern was scored with whole numbers from 1 to 5 based on the color of elastographic images.Score 1 and 2 were classified as benign and score 3 to 5 as malignancy. Cytohistology results of EUS-FNA were defined as positive（malignant） when malignant or atypical cells were founded. On the contrary, a negative result was concluded if only benign cells were founded. 【Results】According to the diagnostic criteria of elastography, EUS elastography made the correct conclusion in all patients. As for cytohistology results of EUS-FNA, 18 cases were made the right diagnosis, whereas 3 cases of pancreatic cancer got a false negative conclusion. Furthermore, a detailed type of lesion was made in 14 cases based on EUS-FNA cytohistology finding.【Conclusions】EUS elastography has high accuracy for both pancreatic mass and other neoplasm in upper digestive tract and its peripheral areas,it can provide a complementary method especially when EUS-FNA is negative or cannot be performed because of technical problems.

关 键 词：内镜超声检查 弹性成像 诊断 活组织检查 

分 类 号：R445.1[医药卫生—影像医学与核医学]