基于智能手机的实时远程快速现场评估在超声内镜引导细针穿刺抽吸中的价值  

Value of smart phone-assisted instant telecytopathology for rapid on-site evaluation in endoscopic ultrasound-guided fine needle aspiration

作　　者：李真[1,2,3] 赵雨莎 苏鹏[4] 王晓[4] 贾晓青[1,2,3] 王立梅 王鹏[1,2,3] 左秀丽[1,2,3] 李延青[1,2,3] 钟宁[1,2,3] Zhen Li;Yusha Zhao;Peng Su;Xiao Wang;Xiaoqing Jia;Limei Wang;Peng Wang;Xiuli Zuo;Yanqing Li;Ning Zhong(Department of Gastroenterology,Qilu Hospital of Shandong University,Jinan 250012,China;Laboratory of Translational Gastroenterology,Qilu Hospital of Shandong University,Jinan 250012,China;Robot Engineering Laboratory for Precise Diagnosis and Therapy of Gastrointestinal Tumor,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Pathology,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院消化内科,济南250012 [2]山东大学齐鲁医院胃肠疾病转化医学实验室,济南250012 [3]山东大学齐鲁医院胃肠道肿瘤机器人精准诊疗工程实验室,济南250012 [4]山东大学齐鲁医院病理科,济南250012

出　　处：《中华消化内镜杂志》2023年第5期365-371,共7页Chinese Journal of Digestive Endoscopy

基　　金：国家重点研发计划(2021YFE0202000);山东省重点研发计划(2019JZZY011007);山东大学临床研究中心项目(2020SDUCRCC022)。

摘　　要：目的探讨联合智能手机实时图片交流进行远程快速现场评估(rapid on-site evaluation,ROSE)的可行性,以及远程ROSE在提高超声内镜医师诊断效率中的作用。方法回顾性分析2020年4月—2021年5月于山东大学齐鲁医院接受超声内镜引导细针穿刺抽吸术(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)诊断的188例患者资料。其中2020年4—10月未行ROSE的为非ROSE组(91例),2020年11月—2021年5月引入了ROSE的为ROSE组(97例),ROSE组中2020年11月—2021年3月为手机组(52例),即内镜医师通过智能手机微信发送ROSE图像给细胞病理医师;2021年4—5月为self-ROSE组(45例),由经过细胞病理培训的超声内镜医师独立判断ROSE结果。比较患者基本信息、ROSE结果、术后病理及术后随访情况,分析远程ROSE的诊断效能。结果188例患者中179例(95.2%)为胰腺实性病变,9例(4.8%)为腹腔病变。非ROSE组、手机组、self-ROSE组穿刺次数差异无统计学意义[3(3,4)比3(3,4)比3(2,4),H=1.320,P=0.517]。以最终诊断为金标准,非ROSE组诊断的敏感度、特异度、准确率、阳性预测值、阴性预测值、Kappa值分别为80.6%(58/72)、89.5%(17/19)、82.4%(75/91)、96.7%(58/60)、54.8%(17/31)、0.6,ROSE组相应指标为97.4%(74/76)、100.0%(21/21)、97.9%(95/97)、100.0%(74/74)、91.3%(21/23)、0.9,手机组为95.2%(40/42)、100.0%(10/10)、96.2%(50/52)、100.0%(40/40)、83.3%(10/12)、0.9,self-ROSE组为100.0%(34/34)、100.0%(11/11)、100.0%(45/45)、100.0%(34/34)、100.0%(11/11)、1.0。ROSE组的敏感度(P=0.002)、准确率(P=0.001)和阴性预测值(P=0.009)高于非ROSE组,其余诊断效能指标差异无统计学意义(P>0.05)。手机组和self-ROSE组上述诊断效能指标差异无统计学意义(P>0.05)。结论智能手机微信辅助下实时远程ROSE能很好地适应病理科及超声内镜医师需求,远程ROSE应用后内镜医师诊断准确率与细胞病理医师相当,有助于内镜下获得更充分的标本,提高EUSObjective To explore the feasibility of smart phone real-time picture exchange-assisted telecytopathology for rapid on-site evaluation(tele-ROSE),and the role of tele-ROSE in improving the diagnostic efficiency of endoscopic physicians.Methods Data of patients who underwent endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)from April 2020 to May 2021 in Qilu Hospital of Shandong University were retrospectively collected.Patients who didn't receive ROSE from April 2020 to October 2020 were enrolled in the non-ROSE group,and those who underwent ROSE from November 2020 to May 2021 were enrolled in the ROSE group,of which endosonographers used WeChat on the smartphone to send ROSE images to cytopathologists from November 2020 to March 2021 were the mobile phone group,and those whose ROSE results independently diagnosed by trained endosonographers from April 2021 to May 2021 were the self-ROSE group.Basic information,ROSE results,postoperative pathology and follow-up were compared,and the diagnostic effectiveness of tele-ROSE was analyzed.Results A total of 188 cases were included,of which 179 cases(95.2%)were solid pancreatic lesions and 9(4.8%)were enterocoelia lesions.There was no significant difference in the puncture time among the non-ROSE,mobile phone and self-ROSE groups[3(3,4)VS 3(3,4)VS 3(2,4),H=1.320,P=0.517].With the final diagnosis as the golden standard,the sensitivity,the specificity,the accuracy,the positive predictive value,the negative predictive value and Kappa value of the non-ROSE group were 80.6%(58/72),89.5%(17/19),82.4%(75/91),96.7%(58/60),54.8%(17/31),and 0.6 respectively.The corresponding indices in the ROSE group were 97.4%(74/76),100.0%(21/21),97.9%(95/97),100.0%(74/74),91.3%(21/23),and 0.9 respectively,those of the mobile phone group were 95.2%(40/42),100.0%(10/10),96.2%(50/52),100.0%(40/40),83.3%(10/12),and 0.9 respcetively,and those of the self-ROSE group were 100.0%(34/34),100.0%(11/11),100.0%(45/45),100.0%(34/34),100.0%(11/11),and 1.0 respectively.The sensitivity(P=0.002),the

关 键 词：远程病理学 快速现场评估 超声内镜引导下细针穿刺抽吸术 智能手机 

分 类 号：R57[医药卫生—消化系统]