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中华胃肠内镜电子杂志 ›› 2024, Vol. 11 ›› Issue (03) : 147 -152. doi: 10.3877/cma.j.issn.2095-7157.2024.03.002

论著

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
程冰倩1, 柴宁莉2,(), 杜晨2, 王湛博3, 李惠凯2, 冯秀雪2, 高飞4, 令狐恩强2,()   
  1. 1. 100853 北京,解放军总医院第一医学中心消化内科医学部;100853 北京,解放军总医院解放军医学院
    2. 100853 北京,解放军总医院第一医学中心消化内科医学部
    3. 100853 北京,解放军总医院第一医学中心病理科
    4. 100853 北京,解放军总医院第一医学中心消化内科医学部;100034 北京,军委机关事务管理总局
  • 收稿日期:2023-11-21 出版日期:2024-08-15
  • 通信作者: 柴宁莉, 令狐恩强
  • 基金资助:
    解放军总医院青年基金(22QNFC056)

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

Bingqian Cheng1, Ningli Chai2,(), Chen Du2, Zhanbo Wang3, Huikai Li2, Xiuxue Feng2, Fei Gao4, Enqiang Linghu2,()   

  1. 1. Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Chinese PLA Medical School, Beijing 100853, China
    2. Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
    3. Department of Pathology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
    4. Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; Government Offices Administration of The Central Military Commission, Beijing 100034, China
  • Received:2023-11-21 Published:2024-08-15
  • Corresponding author: Ningli Chai, Enqiang Linghu
引用本文:

程冰倩, 柴宁莉, 杜晨, 王湛博, 李惠凯, 冯秀雪, 高飞, 令狐恩强. 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[J]. 中华胃肠内镜电子杂志, 2024, 11(03): 147-152.

Bingqian Cheng, Ningli Chai, Chen Du, Zhanbo Wang, Huikai Li, Xiuxue Feng, Fei Gao, Enqiang Linghu. Clinical application of EUS-guided through-the-needle biopsy in differentiation of pancreatic cystic neoplasms[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2024, 11(03): 147-152.

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.

图1 EUS扫查,记录病变位置、大小及有无分隔、壁结节、实性成分
图2 EUS-TTNB小活检钳经穿刺针进入囊腔,钳取囊壁组织
表1 患者基线资料[例(%)]
表2 TTNB诊断效能的影响因素[例(%)]
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