快速线上评估在胰腺实性病变内镜超声引导下细针抽吸术中的应用价值(含视频)  

Assessment of rapid on-line evaluation of endoscopic ultrasound-guided fine needle aspiration for pancreatic masses (with video)

作　　者：蔡云龙[1] 戎龙[1] 年卫东[1] 张继新[2] 刘冠伊 饶小龙 周斌[1] 马永琛 Cai Yunlong;Rong Long;Nian Weidong;Zhang Jixin;Liu Guanyi;Rao Xiaolong;Zhou Bin;Ma Yongchen(Endoscopy Center,Peking University First Hospital,Beijing 100034,China;Department of Pathology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院内镜中心,100034 [2]北京大学第一医院病理科,100034

出　　处：《中华消化内镜杂志》2021年第10期811-816,共6页Chinese Journal of Digestive Endoscopy

基　　金：北京大学第一医院研究种子(2019SF26)。

摘　　要：目的评价快速线上评估(rapid on-line evaluation, ROLE)在胰腺实性病变内镜超声引导下细针抽吸术(endoscopic ultrasonography-guided fine needle aspiration, EUS-FNA)临床诊断中的应用价值。方法回顾性分析2017年10月—2019年10月北京大学第一医院进行EUS-FNA的胰腺实性病变患者资料。根据是否进行ROLE法, 分为ROLE组和对照组。ROLE组根据病理医师判断是否获得足量胰腺组织细胞或异型细胞来决定是否继续穿刺, 对照组根据内镜医师穿刺经验判断是否获得足量肉眼组织条决定是否继续穿刺。EUS-FNA获得的标本由另一位病理医师给出细胞学和组织学诊断, 而最终诊断的金标准基于手术切除标本的组织学诊断, 对于没有接受手术治疗的患者, 最终诊断依据临床病程、影像学、肿瘤标志物和治疗效果反馈等综合结果。比较两组的诊断率、准确率、灵敏度、特异度、穿刺针数、操作时间及并发症发生率等指标。结果共纳入87例患者, 其中ROLE组51例, 对照组36例。ROLE组诊断率高于对照组, 但差异无统计学意义[98.0%(50/51)比86.1%(31/36),P=0.078];ROLE组的穿刺针数少于对照组, 差异有统计学意义(中位数2针比3针, P<0.001);ROLE组的操作时间与对照组相比, 差异无统计学意义(均数19.4 min比18.5 min, P=0.089), 两组在诊断的准确率、灵敏度、特异度、阳性预测值、阴性预测值、并发症发生率上差异均无统计学意义(P>0.05)。结论 ROLE在胰腺实性病变EUS-FNA中能提高穿刺的组织获取量, 减少穿刺针数, 且不明显增加操作的时间和风险。Objective To assess rapid on-line evaluation(ROLE)of endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)for pancreatic masses.Methods Data of patients with solid pancreatic masses who underwent EUS-FNA in Peking University First Hospital from October 2017 to October 2019 were retrospectively analyzed.Patients were divided into the ROLE group and the control group.The number of FNA passes in ROLE group was decided by the cytopathologist based on the number of pancreatic tissue cells or heteromorphic cells obtained,while that in the control group was decided by the endoscopy physician according to the visual observation of tissue strips.The cytological and histological diagnosis of EUS-FNA specimen were made by another cytopathologist.The gold standard for final diagnosis was based on the histological diagnosis of surgically resected specimens.For patients who did not undergo surgical treatment,the final diagnosis was made based on the clinical course,imaging,tumor markers and feedback on treatment.The diagnostic yield,the accuracy,the sensitivity,the specificity,FNA passes,puncture time and adverse events were compared between the two groups.Results A total of 87 patients were enrolled,51 in the ROLE group and 36 in the control group.The diagnostic yield of the ROLE group was higher than that of the control group without significant difference[98.0%(50/51)VS 86.1%(31/36),P=0.078].The number of FNA passes in the ROLE group was significantly less than that in the control group(median 2 VS 3,P<0.001).No significant difference in mean FNA puncture time was found between the ROLE group and the control group(19.4 min VS 18.5 min,P=0.089).There were no significant differences between the two groups with regard to the diagnostic yield,the sensitivity,the specificity,the positive predictive value,the negative predictive value or the incidence of adverse events.Conclusion ROLE of EUS-FNA for pancreatic solid tumor may improve tissue acquisition for puncture,reduce the number of FNA passes,and may not significantly

关 键 词：胰腺肿瘤 诊断 快速线上评估 内镜超声引导下细针抽吸术 

分 类 号：R735.9[医药卫生—肿瘤]