内镜超声引导下细针穿刺抽吸术诊断上消化道及其周围占位病变的价值

Endoscopic ultrasound guided fine needle aspiration in diagnosis of occupying lesions in upper digestive tract and peripheral areas

目的探讨内镜超声引导下细针穿刺抽吸术（EUS—FNA）对上消化道及其周围实质性占位病变诊断的准确性及其临床应用价值。方法对2006年7月-2007年12月间64例因发现上消化道及其周围实质性占位病变而行EUS—FNA患者的临床资料及结果进行回顾性分析。结果共62例患者成功进行了EUS—FNA，穿刺成功率96．88％；EUS—FNA总的诊断准确度88．71％（55／62）、灵敏度86．54％、特异度100．00％、阳性预测值100．00％、阴性预测值58．82％；对于病灶直径〉3cm及43cm者，两者EUS—FNA诊断准确率及平均穿刺次数差异均无统计学意义（P〉0．05）；有实时细胞学诊断者其诊断准确率明显高于无实时诊断者（P=0．029），且平均穿刺次数也明显减少（P=0．001）；应用5ml负压者诊断阳性率显著高于应用10ml负压者（P=0．044）。结论EUS-FNA对上消化道及周围实质性占位病变有着较高的诊断准确度、灵敏度、特异度及阳性预测值，且安全易行，现场实时细胞学诊断及适当的负压将有助于提高诊断的准确性。

Objective To evaluate the accuracy and clinical application of endoscopic uhrasound guided fine needle aspiration （EUS-FNA） in diagnosis of occupying lesions in upper digestive tract and its peripheral areas. Methods The data of 64 patients who underwent EUS-FNA for occupying lesions in upper digestive tract, between July 2006 and December 2007, were retrospectively analyzed. Results EUS-FNA was successfully performed on 62 patients, with a success rate of 96. 88%. The overall diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNA for occupying lesions in upper digestive tract and its peripheral areas were 88. 71%, 86. 54%, 100. 00%, 100. 00%, and 58. 82%, respectively. There was no significant difference between the loci larger and smaller than 3cm （P 〉 0. 05）, regarding the diagnostic accuracy and average puncture numbers. Diagnostic accuracy of those with real-time cytological evaluation was significantly higher than those without （P = 0. 029）, and the puncture numbers were less （P =0. 001 ）. Among the total 99 punctures, the positive diagnostic accuracy of those with 5ml negative pressure suction was significantly higher than those of 10 ml （ P = 0. 044）. Conclusion EUS-FNA is a safe and applicable approach to diagnosis of occupying lesions in upper digestive tract and its peripheral areas with higher diagnostic accuracy, sensitivity, specificity and positive predictive value. Moreover, the real-time cytological evaluation and adequate negative pressure might facilitate the diagnosis accuracy.