内镜超声引导下细针穿刺抽吸术不同处理标本方法对诊断结果的影响

Influence of different sample processing methods on yield of endoscopic ultrasound-guided fine needle aspiration

目的探讨内镜超声引导下细针穿刺抽吸术（EUS—FNA）不同处理标本方法对诊断结果的影响。方法回顾分析2005年2月-2008年9月间由同一内镜超声医师行EUS—FNA检查118例患者的临床资料。依据病理报告将诊断结果分为明确良恶性诊断、可疑恶性、取材不满意3类，比较液基细胞学、现场细胞学和传统细胞学方法的穿刺成功率及诊断敏感性、特异性和准确性。结果现场细胞学方法的穿刺成功率为95．2％（40／42），显著高于传统细胞学方法的68．0％（32／47）（P〈0．05），略高于液基细胞学方法的89．7％（26／29）（P〉0．05）。液基细胞学和现场细胞学方法获得明确良恶性的诊断率分别为82．8％（24／29）和78．6％（33／42），显著高于传统细胞学方法的57．4％（27／47）（P〈0．05）。现场细胞学方法诊断敏感性及准确性均高于传统细胞学和液基细胞学方法，但差异无统计学意义（P〉0．05）。结论现场细胞学方法和液基细胞学方法较传统细胞学方法提高了穿刺成功率，且液基细胞学方法更易于获得明确良恶性的诊断结论。

Objective To compare the yield of endoscopic uhrasonography guided fine needle aspiration （EUS-FNA） with 3 different sample processing methods. Methods The clinical data of 118 patients, who underwent EUS-FNA performed by one physician from February 2005 to September 2008, were retrospectively analyzed. The FNA sample processing methods included liquid-based cytology, on-site cytology and smear method. The pathological diagnosis was classified as definite, suspicious malignancy, dissatisfying sampling and indefinite. Results The success rate of obtaining samples through on-site cytological procedure was 95.2% （40/42）, which was significantly higher than that of conventional smear （32/47, 68%, P 〈 0. 05 ）, and was higher than that of liquid-based cytological method （26/29, 89. 7% ）, but without significant difference （P 〉 0. 05 ）. The yield of definite diagnosis with liquid-based cytology and on-site cytology were 82.8% （24/29） and 78.6% （33/42）, respectively, which were both significantly higher than that of smear method （57.4%, 27/47, P 〈 0. 05 ）. The sensitivity and accuracy of on-site cytology were higher than those of smear method and liquid-based cytology, but without significant differences （ P 〉 0. 05 ）. Conclusion Compared with conventional smear method, on-site cytology and liquid-based cytology yield more results from EUS-FNA.