超声内镜引导下细针穿刺细胞病理学检查对胃肠道间质瘤的诊断及鉴别诊断  

Diagnosis and Differential Diagnosis of Gastrointestinal Stromal Tumor Based on Endoscopic Ultrasonography-guided Fine Needle Aspiration Cytopathology Examination

作　　者：康劲松[1] 程斌 马珩 马晓敏 颜芳 赵雅桐[1] 雷清华[3] Kang Jingsong;Cheng Bin;Ma Heng(FNA Cytology Diagnoses Room of Department of Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Gastroenterology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院外科细胞学诊断室,武汉430030 [2]华中科技大学同济医学院附属同济医院消化内科,武汉430030 [3]华中科技大学同济医学院基础医学院解剖学系,武汉430030

出　　处：《华中科技大学学报（医学版）》2022年第4期526-530,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.81974380)。

摘　　要：目的探讨超声内镜引导下细针穿刺活检(endoscopic ultrasonography-guided fine needle aspiration,EUS-FNA)细胞病理学检查对胃肠道间质瘤的诊断价值。方法选取54例经临床及影像学检查怀疑胃肠道间质瘤的患者进行EUS-FNA,观察其细胞病理学特征,同时行组织病理学及免疫组织化学染色检查。结果54例病例中细胞病理学诊断可疑间质瘤26例,明确诊断间质瘤28例。细胞病理学诊断考虑可疑间质瘤的病例中,有18例经组织病理学检查及免疫组织化学染色证实为间质瘤,3例组织病理学诊断为神经鞘瘤,2例为孤立性纤维性肿瘤,1例为平滑肌肉瘤,1例为腺癌,1例为结核性炎症;28例细胞病理学明确诊断的间质瘤经组织病理学检查及免疫组织化学染色均证实为间质瘤,细胞病理学诊断的准确率达85.19%(46/54)。结论EUS-FNA细胞病理学检查对胃肠道间质瘤的术前诊断具有较高的准确率,但是对其危险程度及预后的判断则需依赖组织病理学及免疫组织化学检查,且需结合患者的临床病史、肿瘤大小、是否有坏死及囊变等进行综合判断。Objective To investigate the diagnostic value of endoscopic ultrasonography-guided fine needle aspiration(EUS-FNA)in gastrointestinal stromal tumor.Methods A total of 54 patients with suspected gastrointestinal stromal tumor according to clinical observation and radiology were recruited for EUS-FNA.The cytopathological characteristics were observed under microscope.The histopathological examination and immunohistochemical staining were performed at the same time.Results Among the 54 cases,there were 26 suspected stromal tumor cases and 28 definite diagnosis cases according to cytopathology.Among the suspected cases,18 cases were confirmed as stromal tumors by histopathological examination and immunohistochemical staining,3 cases were histopathologically diagnosed as schwannomas,2 cases as solitary fibrous tumors,1 case as leiomyosarcoma,1 case as adenocarcinoma,and 1 cases as tuberculous inflammation.All 28 definite cases diagnosed by cytopathology were confirmed to be stromal tumor by pathological examination and immunohistochemical staining.The accuracy rate of cytopathological diagnosis was 85.19%(46/54).Conclusion EUS-FNA has a high accuracy in preoperative diagnosis of gastrointestinal stromal tumor.But the evaluation of risk level and prognosis still depends on histopathology and immunohistochemistry methods,with combination of patient’s clinical history,tumor size,necrosis condition and cystic changes.

关 键 词：超声内镜引导下细针穿刺 细胞病理学 胃肠道间质瘤 鉴别诊断 

分 类 号：R735[医药卫生—肿瘤]