Clinical application of endoscopic ultrasound guided fine needle aspiration biopsy in pancreatic space-occupying lesions
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摘要:
目的 探讨超声内镜引导下细针抽吸活检术（EUS-FNA）在胰腺占位性病变中的临床应用特点。 方法 选择2018年1月~2022年1月于本院因可疑胰腺占位性病变行EUS-FNA检查的55例患者作为研究对象，患者年龄62.91±11.21岁，其中男性29例、女性26例。以穿刺样本的组织学病理结果为金标准，分析行EUS-FNA检查患者的一般临床资料及其病变特点、胰管情况、穿刺次数及术后并发症等。评价EUS-FNA诊断胰腺占位性病变的敏感度、特异性、准确度，以及影响准确性的临床因素。 结果 55例患者均成功进行EUS-FNA，穿刺成功率100%，所有患者获得穿刺病理。术后不良反应2例，其中1例为腹痛，1例为高淀粉酶血症，经临床常规处理后均恢复良好。经EUS-FNA诊断明确的有48例（87.27%），诊断未明确的有7例（12.73%），诊断敏感度为92.31%（48/52），特异性为100%（3/3），准确度为92.73%（51/55），阳性预测值为100%（48/48），阴性预测值为42.86%（3/7）；EUS-FNA的准确性与患者年龄、胰管扩张情况有关（P < 0.05），与性别、血糖、肿瘤标记物、病灶性状、病变大小、部位、穿刺针数、细胞学检查方法等无关（P > 0.05）。 结论 EUS-FNA对胰腺占位性病变诊断的敏感度、特异性、准确度均很高，并发症少见且轻微，为临床提供了有效的诊断方法。 -
关键词:
- 胰腺占位性病变 /
- 超声内镜引导下细针抽吸活检术 /
- 病理学检查
Abstract:Objective To investigate the clinical application of endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) biopsy in pancreatic space occupying lesions. Methods Fifty-five patients who underwent EUS-FNA examination for suspected pancreatic space-occupying lesions in the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2022 were screened, with an average age of 62.91±11.21 years, including 29 males and 26 females. The general clinical data, lesion characteristics, pancreatic duct conditions, puncture times and postoperative complications of patients undergoing EUS-FNA were analyzed, with the histopathological results of puncture samples as the gold standard. We evaluated the sensitivity, specificity, and accuracy of EUS-FNA in diagnosing pancreatic space-occupying lesions, as well as the clinical factors affecting the accuracy. Results EUS-FNA was successfully performed in all these 55 patients, the puncture success rate was 100%, and puncture pathology was obtained in all patients. Postoperative adverse reactions occurred in 2 cases, including abdominal pain in 1 case and hyperamylasemia in 1 case. All patients recovered well after routine clinical treatment. Forty-eight cases (87.27%) were definitely diagnosed by EUS-FNA, and 7 cases (12.73%) were not definitely diagnosed. The diagnostic sensitivity was 92.31% (48/52), specificity was 100% (3/3), accuracy was 92.73% (51/55), positive predictive value was 100% (48/48), negative predictive value was 42.86% (3/7). The accuracy of EUS-FNA was related to the patient's age and pancreatic duct dilatation (P < 0.05), but not gender, blood glucose, tumor markers, lesion characteristics, lesion size, location, times of puncture needles, cytological examination methods (P > 0.05). Conclusion EUS-FNA has high sensitivity, specificity and accuracy in the diagnosis of pancreatic space occupying lesions. The complications are rare and mild, which provides an effective diagnostic method for clinical practice. -
图 2 胰头占位性病变EUS-FNA图像
A: 可见胰腺头部见不均匀低回声病变, 边界欠清, 病灶最大截面约20.8 mm×25.5 mm, 如红色箭头所示; B: 胰腺头部病变EUS彩色多普勒显示见少许血流信号，如蓝色箭头所示; C: EUS彩色多普勒观察病变及穿刺点周围血流情况, 如红色箭头所示; D: 选择胰头穿刺点后, 在彩色多普勒引导下确定穿刺深度, 用COOK 22 G穿刺针穿刺胰腺低回声病变, 蓝色箭头所示为穿刺针.
Figure 2. EUS-FNA image of pancreatic head occupying lesion
表 1 EUS-FNA对胰腺占位性病变的诊断影响因素分析
Table 1. Analysis of factors affecting the diagnosis of pancreatic space-occupying lesions by EUS-FNA
影响因素 EUS-FNA P 诊断明确（n=48） 诊断未明确（n=7） 年龄（岁, Mean±SD） 64.58±10.14 51.43±12.26 0.003 性别[n(%)] 0.335 男 27(93.10) 2(6.90) 女 21(80.77) 5(19.23) 血糖（mmol/L） 5.93（5.13~7.34） 6.24（4.89~7.10） 0.820 肿瘤标记物 CA19-9（U/mL） 61.00（5.85~228.18） 20.60（15.91~82.21） 0.762 CEA（ng/mL） 3.43（2.06~8.14） 2.81（2.56~4.07） 0.860 AFP（ng/mL） 3.05（2.40~5.36） 2.38（1.60~3.18） 0.245 CA153（U/mL） 7.15（5.01~10.68） 8.60（6.20~14.10） 0.216 病灶性状[n(%)] 0.266 实性 40(90.91) 4(9.09) 囊实性 8(72.73) 3(27.27) 病变部位[n(%)] 0.246 胰头 29(82.86) 6(17.14) 胰体 12(92.31) 1(7.69) 胰尾 7(100.00) 0(0) 胰管情况[n(%)] 0.019 扩张 42(93.33) 3(6.67) 不扩张 6(60.00) 4(40.00) 病灶最大直径[cm, n(%)] 0.421 ≤2 10(76.92) 3(23.08) > 2 38(90.48) 4(9.52) 穿刺针数[n(%)] 0.796 ≤2次 21(84.00) 4(16.00) ≥3次 27(90.00) 3(10.00) 
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表 2 EUS-FNA穿刺诊断结果及最终诊断结果
Table 2. EUS-FNA puncture diagnosis results and final diagnosis results
诊断结果 EUS-FNA结果（n） 最终诊断例数（n） 构成比（%） 诊断明确 诊断未明确 胰腺囊实性占位 9 2 11 20.00 囊腺瘤 6 1 7 12.73 导管内乳头状粘液瘤 2 1 3 5.45 浆液性囊腺瘤 1 0 1 1.82 胰腺实性占位 39 2 41 74.55 胰腺癌 33 1 34 61.82 炎性病变 4 0 4 7.27 神经内分泌肿瘤 2 1 3 5.45 未明确的病变 0 3 3 5.45 合计 48 7 55 100.00
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