经培训内镜医师实施快速现场评估在内镜超声引导下细针抽吸术诊断胰腺实性占位中的价值  

Value of on-site cytopathology evaluation by trained endoscopists during endoscopic ultrasoundguided-fine needle aspiration for solid pancreatic lesions

作　　者：张松[1,2] 郑金榆[3] 倪牧含[2] 徐桂芳 彭春艳[2] 沈珊珊[2] 张玮[2] 黄淑玲[2] 王雷[2] 邹晓平[2] 吕瑛[2] Zhang Song;Zheng Jinyu;Ni Muhan;Xu Guifang;Peng Chunyan;Shen Shanshan;Zhang Wei;Huang Shuling;Wang Lei;Zou Xiaoping;Lyu Ying(Department of Gastroenterology,Drum Tower Clinical College of Integrative Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210008,China;Department of Gastroenterology,The Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Pathology,The Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京中医药大学中西医结合鼓楼临床医学院消化内科,210008 [2]南京大学医学院附属鼓楼医院消化内科,210008 [3]南京大学医学院附属鼓楼医院病理科,210008

出　　处：《中华消化内镜杂志》2020年第11期799-804,共6页Chinese Journal of Digestive Endoscopy

基　　金：江苏省自然科学基金面上项目(SBK2019022491);南京市医学科技发展资金资助项目(ZKX18022,YKK17077)。

摘　　要：目的探讨经培训内镜医师实施快速现场评估(rapid on-site evaluation by endoscopic physicians themselves,self-ROSE)在胰腺实性占位内镜超声引导下细针抽吸术(endoscopic ultrasoundguided-fine needle aspiration,EUS-FNA)中的应用价值。方法回顾性分析2017年1-12月在南京鼓楼医院接受EUS-FNA的连续124例胰腺实性占位患者的临床资料。2017年7-12月的病例行self-ROSE,纳入self-ROSE组(60例);2017年1月-2017年6月的病例未行self-ROSE,纳入非self-ROSE组(64例)。比较self-ROSE组与非self-ROSE组患者EUS-FNA的诊断效能(灵敏度、特异度、阳性预测值、阴性预测值和准确率)、穿刺次数及并发症发生率等指标。结果self-ROSE组的EUS-FNA诊断灵敏度、特异度、阳性预测值、阴性预测值、准确率分别为98.21%(55/56)、4/4、100.00%(55/55)、4/5和98.33%(59/60),而非self-ROSE组的EUS-FNA诊断灵敏度、特异度、阳性预测值、阴性预测值、准确率分别为81.82%(45/55).9/9.100.00%(45/45)、47.37%(9/19)和84.38%(54/64)。self-ROSE组EUS-FNA的灵敏度(P=0.004)和准确率(P=0.009)均显著高于非self-ROSE组。在样本满意程度评估(Kappa=1.000,P<0.05)和细胞病理学评估(Kappa=0.815,P<0.05)方面,内镜医师与病理医师均呈现出高度的一致性。2组患者穿刺次数差异无统计学意义[(2.78±0.83)针比(2.61±0.75)针,P>0.05]。2组均无并发症发生。结论self-ROSE有助于提升胰腺实性占位EUS-FNA的诊断效能,可作为提高EUS-FNA诊断准确率的重要策略。Objective To analyze the application value of rapid on-site evaluation by endoscopic physicians themselves(self-ROSE)of endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)for solid pancreatic lesions.Methods Data of 124 consecutive patients who underwent EUS-FNA for solid pancreatic lesions from January 2017 to December 2017 in Nanjing Drum Tower Hospital were retrospectively analyzed.The patients were divided into self-ROSE group(n=60,patients who received self-ROSE from July to December in 2017)and non-self-ROSE group(n=64,patients who didn5 t receive self-ROSE from January to June in 2017).Diagnostic efficiency including sensitivity,specificity,positive predictive value,negative predictive value and accuracy,the number of punctures and complication incidence of EUS-FNA in self-ROSE group and non-self-ROSE group was compared.Results The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of EUS-FNA were 98.21%(55/56),4/4,100.00%(55/55),4/5 and 9&33%(59/60),respectively in self-ROSE group.While in non-self-ROSE group,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 81.82%(45/55),9/9,100.00%(45/45),47.37%(9/19)and 84.38%(54/64),respectively.The sensitivity(P=0.004)and accuracy(P=0.009)were both significantly higher during EUS-FNA in self-ROSE group than those in non-self-ROSE group.There was a high degree of consistency between endoscopists and pathologists in the evaluation of sample satisfaction(Kappa=1.000,P<0.05)and cytopathological diagnosis(Kappa=0.815,P<0.05).There was no significant difference in the number of punctures between the two groups(2.78±0.83 VS 2.61±0.75,P>0.05).No complication occurred in either group.Conclusion Self-ROSE is valuable for EUS-FNA in the diagnosis of solid pancreatic lesions,which could be an important strategy to increase the accuracy of EUS-FNA.

关 键 词：腔内超声检查 胰腺疾病 内镜医师 快速现场评估 准确率 

分 类 号：R445.1[医药卫生—影像医学与核医学] R576[医药卫生—诊断学]