细胞病理医师与经过培训内镜医师在超声内镜引导细针穿刺抽吸术中应用快速现场评估诊断胰腺实性占位性病变的对比研究  

Comparative study of rapid on-site evaluation performed by cytopathologists and trained endoscopists during endoscopic ultrasound-guided fine needle aspiration for pancreatic solid lesions

作　　者：林吟 邹东东 李燕维 吴以龙 林敏 杨沱 Lin Yin;Zou Dongdong;Li Yanwei;Wu Yilong;Lin Min;Yang Tuo(Department of Gastroenterology,Fuding Hospital,Fujian University of Traditional Chinese Medicine,Ningde 355200,China;Department of Proctology,Fuding Hospital,Fujian University of Traditional Chinese Medicine,Ningde 355200,China;Department of Pathology,Fuding Hospital,Fujian University of Traditional Chinese Medicine,Ningde 355200,China)

机构地区：[1]福建中医药大学附属福鼎医院消化内科,宁德355200 [2]福建中医药大学附属福鼎医院肛肠科,宁德355200 [3]福建中医药大学附属福鼎医院病理科,宁德355200

出　　处：《中华消化内镜杂志》2023年第10期771-777,共7页Chinese Journal of Digestive Endoscopy

基　　金：宁德市自然科学基金联合项目((2023)25)。

摘　　要：目的探讨快速现场评估(rapid on-site evaluation,ROSE)在超声内镜引导细针穿刺抽吸术(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)诊断胰腺实性占位性病变中的价值,并比较细胞病理医师与经过培训内镜医师进行ROSE的差异。方法本研究为回顾性病例对照研究,将2014年1月—2020年12月于福建中医药大学附属福鼎医院因胰腺实性占位性病变行EUS-FNA并得出细胞学诊断的168例连续病例作为研究对象。2014年1月—2017年11月行EUS-FNA的患者均未行ROSE,纳入N-ROSE组,共67例;2017年12月以后采用随机数字表法将拟行ROSE的患者分为E-ROSE组和C-ROSE组,E-ROSE组由经过细胞病理学培训的内镜医师进行EUS-FNA和ROSE,共59例;C-ROSE组由未经过培训的内镜医师进行EUS-FNA,然后由细胞病理医师进行ROSE,共42例。比较3组患者的穿刺次数、样本充分率、细胞学诊断、最终诊断和诊断效能(诊断灵敏度、特异度、阳性预测值、阴性预测值和准确率)等指标。结果(1)N-ROSE组的穿刺次数为(4.22±0.76)次,明显多于E-ROSE组的(3.12±0.79)次(P<0.001)和C-ROSE组的(3.24±0.91)次(P<0.001)。(2)N-ROSE组样本充分率为82.09%(55/67),明显低于E-ROSE组的96.61%(57/59)(χ^(2)=5.308,P=0.021)和C-ROSE组的97.62%(41/42)(χ^(2)=4.541,P=0.033)。而N-ROSE组细胞学阴性的比例为40.30%(27/67),明显高于E-ROSE组的20.34%(12/59)(χ^(2)=5.848,P=0.016)和C-ROSE组的19.05%(8/42)(χ^(2)=5.348,P=0.021)。(3)N-ROSE组的灵敏度为74.07%(40/54),明显低于E-ROSE组的94.00%(47/50)(χ^(2)=6.151,P=0.013)和C-ROSE组的94.44%(34/36)(χ^(2)=4.817,P=0.028)。N-ROSE组的准确率为79.10%(53/67),也明显低于E-ROSE组的94.92%(56/59)(χ^(2)=5.433,P=0.020)和C-ROSE组的95.24%(40/42)(χ^(2)=4.155,P=0.042)。(4)E-ROSE组与C-ROSE组在所有指标之间比较差异均无统计学意义(P>0.05)。结论ROSE可以有效提高样本充分率、诊断灵敏度和准确率,同时减少穿刺次数。经过细胞病理学培训的Objective To evaluate rapid on-site evaluation(ROSE)in endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)for pancreatic solid lesions,and to compare the difference in ROSE performance between cytopathologists and trained endoscopists.Methods A total of 168 consecutive patients with pancreatic solid lesions who underwent EUS-FNA from January 2014 to December 2020 at Fuding Hospital,Fujian University of Traditional Chinese Medicine were recruited.The patients who did not receive ROSE from January 2014 to November 2017 were included in N-ROSE group(n=67).Since December 2017,the patients who intended to receive EUS-FNA were divided into E-ROSE group(n=59,patients who received EUS-FNA and ROSE by endoscopists trained with cytopathology)and C-ROSE group(n=42,patients who received EUS-FNA by untrained endoscopists and ROSE by cytopathologists)according to random number table.The number of punctures,sample adequacy,cytological diagnosis,final diagnosis and diagnostic efficiency(including the sensitivity,the specificity,the positive predictive value,the negative predictive value and the accuracy)in 3 groups were compared.Results(1)The puncture number in N-ROSE group(4.22±0.76)was significantly more than E-ROSE group(3.12±0.79,P<0.001)and C-ROSE group(3.24±0.91,P<0.001).(2)The proportions of adequate samples in N-ROSE group[82.09%(55/67)]was significantly lower than those of E-ROSE group[96.61%(57/59),χ^(2)=5.308,P=0.021]and C-ROSE group[97.62%(41/42),χ^(2)=4.541,P=0.033].The proportion of negative cytological diagnosis in N-ROSE group[40.30%(27/67)]was significantly higher than those of E-ROSE group[20.34%(12/59),χ^(2)=5.848,P=0.016]and C-ROSE group[19.05%(8/42),χ^(2)=5.348,P=0.021].(3)The sensitivity of N-ROSE group[74.07%(40/54)]was significantly lower than those of E-ROSE group[94.00%(47/50),χ^(2)=6.151,P=0.013]and C-ROSE group[94.44%(34/36),χ^(2)=4.817,P=0.028].The accuracy in N-ROSE group[79.10%(53/67)]was significantly lower than those of E-ROSE group[94.92%(56/59),χ^(2)=5.433,P=0.020]and C-ROSE

关 键 词：胰腺疾病 快速现场评估 内镜医师 细胞病理医师 

分 类 号：R735.9[医药卫生—肿瘤]