细胞块结合免疫组化在内镜超声引导下穿刺诊断胰腺实性占位中的应用价值  

The diagnostic value of endoscopic ultrasound-guided fine-needle aspiration biopsy of cell block with immunostaining for pancreatic lesions

作　　者：覃山羽[1] 姜海行[1] 李萍[2] 陈志敏[1] 张湘莲[1] 雷荣娥[1] 杨显文[1] 

机构地区：[1]广西医科大学第一附属医院消化内科,南宁530021 [2]广西医科大学第一附属医院病理科,南宁530021

出　　处：《中华消化内镜杂志》2014年第6期312-316,共5页Chinese Journal of Digestive Endoscopy

基　　金：广西科技厅资助（桂科自0728072）

摘　　要：目的探讨超声内镜引导下细针穿刺（EUS—FNA）物行不同细胞学检查方法对胰腺占位性病变的诊断价值。方法前瞻性研究广西医科大学第一附属医院2012年3月至2013年6月收治的胰腺实性占位性病变72例，均行超声内镜引导下细针穿刺活检取材，分别行常规涂片、液基涂片及细胞块结合免疫组化检查。结果72例患者中，最终确诊胰腺肿瘤61例，包括胰腺癌55例、胰腺假乳头状瘤2例、胰腺内分泌肿瘤4例；良性病变11例，包括慢性胰腺炎4例、胰腺结核2例、胰腺炎4例、黏液性囊腺瘤1例。常规涂片、液基涂片和细胞块结合免疫组化对胰腺肿瘤的诊断敏感度分别为68．9％（42／61）、75．4％（46／61）和90．2％（55／61），特异度均为100．0％，准确率分别为73．6％（53／72）、79．2％（57／72）和91．7％（66／72），细胞块结合免疫组化诊断准确率高于常规涂片细胞学及液基细胞学（P均〈0．05）。术后患者均无出血、感染、急性胰腺炎等并发症。结论EUS—FNA是一种安全有效的诊断胰腺占位病变的方法，具有高敏感度和特异度。EUS—FNA细胞块结合免疫组化有助于胰腺实性占位病变的定性诊断和组织学分型诊断，对治疗方案的选择有较大的临床应用价值。Objective To evaluate the diagnostic value of the cell block （CB） with immunostaining method by endoscopic ultrasound-guided fine-needle aspiration （EUS-FNA） biopsy for pancreatic lesions. Methods A total of 72 patients with pancreatic lesions underwent EUS-FNA at the First Affiliated Hospital of Guangxi Medical University from March 2012 to June 2013. The EUS-FNA samples of all patients were processed by conventional smear cytology, liquid-based cytology （LBC） and the cell block with immunos- taining. Results There were 61 pancreatic patients who were finally diagnosed as having pancreatic tumors, including 55 cases of pancreatic cancer, 2 pancreatic solid pseudopapillary tumor, 4 pancreatic endocrine tumors （PETs） , and 11 benign lesions： 4 chronic pancreatitis, 2 pancreatic tuberculosis ,4 pancreatitis and 1 pancreatic mucinous cystadenoma. The diagnostic sensitivity of conventional smear cytology, liquid-based cytology and cell block with immuno-staining method were 68. 9% （42/61）, 75.4% （46/61） and 90. 2% （ 55/61 ） , respectively. The diagnostic specificity of three methods were all 100.0%. The diagnostic accura- cy rates were 73.6% （53/72） ,79. 2% （57/72） and 91.7% （66/72）, respectively. The diagnostic accuracy rate of the cell block with immunostaining was higher than those of conventional smear cytology （ P 〈 0. 05） and the liquid-based cytology （P 〈 0. 05 ）. Conclusion Endoscopic ultrasound-guided fine-needle aspiration is a safe and effective method with high sensitivity and specificity in the diagnosis of pancreatic lesions. Cell block method combining immunohistochemistry helps to increase the diagnosis and histological diagnosis of pancreatic lesions. The cell block has a greater clinical value in the diagnosis of pancreatic lesions.

关 键 词：腔内超声检查 细针穿刺 液基细胞学 细胞块 胰腺占位病变 

分 类 号：R735.9[医药卫生—肿瘤]