腹腔及腹膜后占位病变的EUS-FNA细胞学和组织学诊断价值

The Value of EUS-FNA Cytological and Histological Detection in Diagnosis of Peritoneal and Retroperitoneal Space-Occupying Lesions

目的探讨腹腔及腹膜后占位病变的内镜超声引导下细针穿刺(EUS-FNA)细胞学及组织学检查的诊断价值。方法对103例腹腔及腹膜后占位病变行EUS-FNA活检,同时制备细胞学涂片及组织学石蜡切片。根据存档的细胞学涂片及组织学切片分类,将本组不同发病部位的细胞学诊断与组织学诊断结果进行比较,对两者结果不符合的病例进行分析。结果 103例腹腔及腹膜后占位病变中,腹腔及腹膜后淋巴结及其他病变43例,胰腺29例,胃肠道20例,肝脏11例。EUS-FNA细胞学与组织学诊断符合64例(62.14%),不符合39例(37.86%),其中细胞学诊断为良性61例中,组织学诊断为良性44例,异型9例,恶性8例;细胞学诊断为异型25例中,组织学诊断为良性5例,异型6例,恶性14例;细胞学诊断为恶性17例中,组织学诊断为良性2例,异型1例,恶性14例。经kappa一致性检验,仅胃肠道占位病变的细胞学诊断与组织学诊断一致性比较,差异无统计学意义(P>0.05);其他病变部位的一致性比较,差异均有统计学意义(P<0.05)。腹腔及腹膜后占位病变EUS-FNA细胞学与组织学诊断的一致性比较,差异有统计学意义(P<0.001)。两种诊断方法对照,EUS-FNA细胞学诊断敏感性为67.3%,特异性为86.3%,阳性预测值为83.3%,阴性预测值为72.1%。结论 EUS-FNA细胞学及组织学检查对腹腔及腹膜后占位病变诊断价值较高,诊断一致性较好,且两者可相互印证及补充。

Objective To explore the value of cytological and histological diagnosis in the peritoneal and retroperitoneal space-occupying lesions by EUS-guided fine-needle aspiration（EUS-FNA）.Methods 103 patients with peritoneal and retroperitoneal space-occupying lesions underwent EUS-FNA biopsy detection,the results of cytological diagnosis of different sites were compared with that of histological diagnosis according to the categorizations of madden cytological smears and paraffin sections,and the results,which were nonconformity,were analyzed.Results Among 103 patients with peritoneal and retroperitoneal space-occupying lesions,43 had lesions on peritoneal and retroperitoneal lymph nodes,with 29 on pancreas,20 on gastrointestinal tract,and 11 on liver.EUS-FNA Cytological diagnosis was coincident with histological diagnosis in 64 patients（62.14%）,and not coincident in 39 patients（37.86%）.61 patients was diagnosed as having benign lesions by cytological detection.Among those who were detected by histology,44 were diagnosed as having benign lesions,9 were atypia,and 8 were malignant;61 patients was diagnosed as having atypia lesions by cytological detection.Among those who were detected by histology,5 were diagnosed as having benign lesions,6 were atypia,and 14 were malignant;17 patients was diagnosed as having malignant lesions by cytological detection.Among those were detected by histology,2 were diagnosed as having benign lesions,1 was atypia,and 14 were malignant.Tested by kappa consistency check,no significant difference was found between cytological diagnosis and histological diagnosis in gastrointestinal tract space-occupying lesions;there were significant differences between cytological diagnosis and histological diagnosis in other sites（P0.05）.There were significant differences between EUS-FNA cytological diagnosis and histological diagnosis in peritoneal and retroperitoneal space-occupying lesions（P0.001）.Compared with the two diagnosis methods,the sensitivity of EUS-FNA cytological diagnosis was 67.3%,specificity was 86.3%,Positive predictive value was 83.3%,and negative predictive value was 72.1%.Conclusion Cytological diagnosis and histological diagnosis by EUS-FNA may be more valuable in diagnosis of peritoneal and retroperitoneal space-occupying lesions,which can confirm and complement each other.