超声内镜引导下细针穿刺结合巴氏细胞学分级诊断胰腺实性病变的价值  

Diagnostic value of endoscopic ultrasound guided fine needle aspiration combined with the new category of papanicolaou .society of cytopathology in solid pancreatic lesions

作　　者：叶乔 陈柯[1] 刘倩倩[1] 郁柳[1] 王舒蓓[1] 徐莹[1] 叶延军[1] 孙蕴伟[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院消化内科,200025

出　　处：《中华消化杂志》2017年第12期823-827,共5页Chinese Journal of Digestion

摘　　要：目的在缺少快速现场评估（ROSE）的条件下，分析超声内镜引导下细针穿刺（EUS-FNA）结合新的巴氏细胞学分级对胰腺实性病灶的诊断价值。方法纳入2011年2月至2014年10月因胰腺实性病灶行EUS-FNA并得出细胞学诊断的225例患者。依据病理、影像学检查和随访结果确诊，计算EUS-FNA结合巴氏细胞学分级鉴别胰腺实性病灶是否为肿瘤性疾病的敏感度、特异度、准确度。危险因素分析采用Logistic回归分析。结果225例胰腺实性病灶患者中，96例（42.7%）为不确定的细胞学诊断结果，其中无法诊断占17.3%（39/225），非典型病变占8.0%（18/225），可疑恶性肿瘤占17.3%（39/225）；129例（57.3%）为确定的细胞学诊断结果，其中良性病变占15.1%（34/225），肿瘤性病变（良性或其他性质）占14.7%（33/225），恶性肿瘤占27.6%（62/225）。当非典型病变的细胞学结果分别被纳入非肿瘤性病变和肿瘤性病变时，诊断的敏感度、特异度、准确度分别为87.3%、91.7%、88.2%和94.7%、72.2%、90.3%。血清CA125≥14 kU/L（OR＝7.13，95%CI 2.02～25.22，P＝0.002）和胆道疾病史（OR＝3.85，95%CI 1.22～12.51，P＝0.022）是肿瘤性病变的独立危险因素。结论尽管有较高比例的细胞学诊断为不确定结果，但是EUS-FNA结合巴氏细胞学分级标准仍有较高的诊断价值。CA125≥14 kU/L和胆道疾病史可能帮助胰腺肿瘤性病变的诊断。ObjectiveTo study the diagnostic value of endoscopic ultrasound guided fine needle aspiration （EUS-FNA） combined with the new category of papanicolaou society of cytopathology in solid pancreatic lesions （SPL） rapid on-site evaluation （ROSE）.Methods From February 2011 to October 2014, 225 patients with SPL who underwent EUS-FNA and obtained the cytological diagnosis were enrolled. The lesions were finally diagnosed according to pathological results, imaging and follow-up data, and then the sensitivity, specificity, and accuracy of EUS-FNA in the diagnosis of SPL were calculated based on the new papanicolaou society of cytopathology terminology. Logistic stepwise regression analysis was performed to analyze the risk factors.ResultsAmong 225 patients with SPL, 96 cases （42.7%） had uncertain cytological diagnosis, 17.3% （39/225） could not be diagnosed, 8.0% （18/225） were atypical lesions, and 17.3% （39/225） were suspicious malignant carcinomas. Among 129 cases （57.3%） with certain cytological diagnosis, 15.1% （34/225） were benign lesions, 14.7% （33/225） were tumors （benign or others） and 27.6% （62/225） were malignant tumors. When atypical lesions were added into non-tumor lesions or tumor lesions, the sensitivity, specificity and accuracy of diagnosis were 87.3%, 91.7%, 88.2%, and 94.7%, 72.2%, 90.3%, respectively. Serum CA125≥14 kU/L （odds ratio （OR）=7.13, 95% confidence interval （CI） 2.02 to 25.22, P=0.002） and history of biliary disease （OR=3.85, 95%CI 1.22 to 12.51, P=0.022） were two independent risk factors of pancreatic tumors.ConclusionsDespite of a high percentage of uncertain cytological diagnosis, EUS-FNA still has high diagnostic value in SPL when combined with the new papanicolaou society of cytopathology terminology. Furthermore, serum CA125≥14 kU/L and history of biliary disease may help to diagnose pancreatic tumors.

关 键 词：超声内镜引导下细针穿刺 胰腺实性病变 诊断 细胞学 

分 类 号：R576[医药卫生—消化系统]