内镜超声引导下胰腺占位性病变细针穿刺液基细胞学诊断  

Liquid-based cytology diagnosis of endoscopic ultrasound-guided fine needle aspiration of pancreatic lesions

作　　者：高莉[1] 张明华[1] 贺相洁 满晓华[2] 朱炎[1] 郑建明[1] 

机构地区：[1]第二军医大学附属长海医院病理科,上海200433 [2]第二军医大学附属长海医院消化内科,上海200433

出　　处：《中华病理学杂志》2016年第1期43-46,共4页Chinese Journal of Pathology

基　　金：第二军医大学长海医院1255科研基金（CH125520806,CH125510304）

摘　　要：目的探讨沉降式液基细胞学（LCT）制片技术在胰腺占位性病变内镜超声引导下细针穿刺（EUS-FNA）细胞学诊断中的应用价值。方法回顾性分析556例胰腺占位的EUS-FNA样本的LCT涂片，参照2014版胰胆管细胞学诊断指南进行分级诊断。其中164例依据手术切除标本或穿刺活检组织病理结合免疫组织化学获得病理诊断，以此为金标准，分析LCT诊断的准确性及影响因素，并分析细胞学诊断错误的原因。结果EUS-FNA的样本满意率96.0%（534/556），LCT诊断的敏感性87.7%（128/146）、特异性13/16、阳性预测值97.7%（128/131）、阴性预测值41.9%（13/31）和诊断准确率87.0%（141/162）。囊性占位的细胞学诊断的准确率低于实性占位；不同组织学类型中，腺癌、淋巴瘤、神经内分泌肿瘤的细胞学敏感性明显高于囊性肿瘤及间叶源性肿瘤。假阳性病例多因炎性反应导致上皮出现不同程度的异型性而报告＂异型＂，假阴性病例多数为穿刺未取到肿瘤细胞或是肿瘤细胞少、异型性小而致漏诊。结论EUS-FNA的LCT检测是诊断胰腺占位的有效工具，统一规范的诊断术语和分类有助于提高诊断的准确性和可重复性。Objective To investigate the diagnostic value of liquid-based cytology test （LCT） in pancreatic lesions sampled by ultrasound-guided fine needle aspiration （EUS-FNA）. Methods A retrospective analysis of 556 cases of LCT smears sampled by EUS-FNA of pancreatic lesions was performed, and 164 cases had histologic diagnosis with subsequent surgical resection or biopsy and immunohistochemistry. The accuracy of the cytologic diagnosis was assessed using the histologic diagnosis as the gold standard. The discrepant eases were reviewed to identify sources of errors. Results The satisfactory rate for EUS-FNA was 96. 0% （534/556）. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 87.7% （ 128/146）, 13/16, 97.7% （ 128/131 ）, 41.9% （13/31） and 87.0% （141/162） respectively. The diagnostic accuracy was lower in cystic lesions than that in solid lesions. The LCT sensitivities of adenocarcinoma, lymphoma and ueuroendocrine tumors were higher than those of cystic tumors and mesenchymal tumors. False positive diagnosis was mainly due to epithelial abnormalities in inflammatory reaction. False negative diagnosis was mainly due to scanty or lack of tumor cells in the smears, or mild atypia that was insufficient for diagnosis. Conclusions EUS-FNA is a valuable tool for the diagnosis of pancreatic lesions. Standardized terminology and nomenclature are helpful to improve the diagnostic accuracy.

关 键 词：胰腺肿瘤 活组织检查 针吸 细胞学技术 病理学 临床 

分 类 号：R735.9[医药卫生—肿瘤]