内镜超声引导下细针穿刺活检对左肾上腺无功能肿块的诊断价值

Evaluation of endoscopic ultrasound guided fine needle aspiration biopsy of left adrenal gland mass

目的探讨在内镜超声引导下细针穿刺活检确定左肾上腺肿块的性质,并评价该种方法对肾上腺病变的诊断价值。方法选择经CT或内镜超声检查发现的左肾上腺无功能肿块患者35例,其中18例患者同时伴有肺部肿块,8例患者同时伴有胃部肿块。对其进行内镜超声检查,以明确病变的大小、形态、位置,在内镜超声导引下对左肾上腺病变行细针穿刺活检。结果全部35例患者均接受了细针穿刺活检,经组织细胞学检查24例为恶性肿瘤(其中鳞状细胞癌,n=9;小细胞癌,n=8;腺癌,n=7),5例为良性肿瘤(腺瘤,n=5),6例为阴性结果。全部患者经手术及临床随访验证,得出EUSFNA诊断肾上腺肿瘤的敏感性为87.9%,特异性为100%。无1例患者出现不良反应。结论内镜超声引导下细针穿刺是诊断左肾上腺病变微创、安全、准确的方法。

[Objective] To perform endoscopic ultrasound guided fine needle aspiration biopsy for diagnosis of the left adrenal gland mass and evaluate the yield and safety of this methods. [Methods] 35 patients with left adrenal gland lesions were selected by EUS and CT. Among these patients, there were 18 patients also with lung lesions and 8 patients with gastric lesions. The shape, size, and position of the left adrenal lesions were assessed. After excluding blood vessel between the lesions and the fine needle, EUS guided fine needle aspiration biopsy were carried out. [Results] All patients were performed fine needle biopsy of the left adrenal gland lesions. Among the 35 patients, Cytology and pathology demonstrated malignant tumors in 24 patients （squamous cell carcinoma, n=9; small cell carcinoma, n=8; adenocarcinoma, n=7）, demonstrated benign tumors in 5 patients （adenoma, n=5） and demonstrated negative results in 6 patients. All the results were evaluated by surgery （n=18）, or by follow-up （n=17）. The sensitivity was 87.9%, speciality was 100% and no complication occurred. [Conclusions] EUS-guided FNA is minimally invasive, a safe and accurate method for diagnosis of left adrenal gland lesions.