超声内镜引导下经穿刺针活检钳活检在胰腺囊性肿瘤诊断中的应用  

Clinical application of EUS-guided through-the-needle biopsy in differentiation of pancreatic cystic neoplasms

作　　者：程冰倩 柴宁莉[1] 杜晨[1] 王湛博[3] 李惠凯[1] 冯秀雪[1] 高飞[1,4] 令狐恩强 Cheng Bingqian;Chai Ningli;Du Chen;Wang Zhanbo;Li Huikai;Feng Xiuxue;Gao Fei;Linghu Enqiang(Department of Gastroenterology,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Chinese PLA Medical School,Beijing 100853,China;Department of Pathology,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Government Offices Administration of The Central Military Commission,Beijing 100034,China)

机构地区：[1]解放军总医院第一医学中心消化内科医学部,北京100853 [2]解放军总医院解放军医学院,北京100853 [3]解放军总医院第一医学中心病理科,北京100853 [4]军委机关事务管理总局,北京100034

出　　处：《中华胃肠内镜电子杂志》2024年第3期147-152,共6页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

基　　金：解放军总医院青年基金(22QNFC056)

摘　　要：目的探讨超声内镜引导下经穿刺针活检钳活检(EUS-TTNB)在胰腺囊性肿瘤(PCNs)诊断中的应用特点。方法回顾自2015年6月至2023年7月解放军总医院第一医学中心前瞻性收集"胰腺囊性肿瘤诊断和治疗研究"数据库。该前瞻性数据库的纳入标准为临床上疑诊为PCNs且患者年龄≥18岁。从数据库中筛选出行EUS-TTNB检查并接受外科手术且术后病理诊断为PCNs的患者。收集患者年龄、性别、病变位置、病变大小、超声内镜下征象(有无分隔、有无壁结节、有无实性成分)、EUS-TTNB结果及外科术后病理结果。评价EUS-TTNB组织获取率,以及在鉴别黏液性和非黏液性囊性肿瘤和诊断特定类型PCNs的诊断阳性率。以外科术后病理结果为金标准,评价EUS-TTNB诊断准确率。结果最终纳入47例,23例在鉴别黏液性和非黏液性肿瘤方面诊断明确、20例诊断未明确、4例组织丢失,诊断阳性率为53.5%(23/43);在诊断特定类型PCNs水平上,19例诊断明确、24例诊断未明确,诊断阳性率为44.2%(19/43)。通过与外科术后病理诊断进行比对,在鉴别黏液性和非黏液性肿瘤上,EUS-TTNB准确率为87.0%(20/23);在诊断特定类型PCNs上,准确率为78.9%(15/19)。在鉴别黏液性和非黏液性及诊断特定类型PCNs两个诊断水平上,诊断明确和诊断未明确病例在有无分隔方面的差异存在统计学意义(P<0.05)。结论EUS-TTNB可作为诊断胰腺囊性肿瘤的辅助检查手段在临床上应用。其诊断效能及影响诊断的因素仍需要进一步的大样本研究。Objective To evaluate the diagnostic performance of endoscopic ultrasonography-guided through-the-needle biopsy(EUS-TTNB)for pancreatic cystic neoplasms(PCNs).Methods Patients who underwent EUS-TTNB examination and surgery,with confirmed PCNs based on postoperative pathology,were screened from our prospective database.The tissue acquisition yield and diagnostic yield of EUS-TTNB were the primary outcomes.The diagnostic accuracy of EUS-TTNB was assessed using postoperative pathology as the gold standard.Results A total of 47 patients were included(37 females and 10 males).The average age was 47.2±13.7 years.The median maximum diameter of the lesions was 46(26)mm.Lesions were located in the head,body,or tail in 14 cases,12 cases,and 20 cases respectively.Four patients had lost EUS-TTNB pathology during sample handling;among the remaining 42 patients,a clear diagnosis for differentiation between mucinous and non-mucinous lesions was achieved in 22 cysts;the diagnostic yield was 52.4%(22/42).In terms of diagnosis for specific types of PCNs,the diagnostic yield was 45.2%(19/42).Compared with surgical pathology,the accuracy of EUS-TTNB in differentiating mucinous and non-mucinous tumors was 86.4%(19/22).For differentiating specific types,the accuracy rate was 78.9%(15/19).In the two levels of diagnosis,there was a statistically significant difference in separation between the diagnostic group and the nondiagnostic group(P<0.05).Conclusion EUS-TTNB can be used as an adjunct method in the diagnosis of PCNs.The diagnostic efficacy and the factors affecting the diagnosis still need to be further studied with large samples.

关 键 词：胰腺囊性肿瘤 超声内镜 经穿刺针活检钳活检 诊断 

分 类 号：R735.9[医药卫生—肿瘤]