超声引导经皮穿刺活检对胰占位性病变的诊断价值

Value of percutaneous needle aspiration biopsy under the guidance of ultrasonography in the diagnosis of space-occupying pancreatic lesions

目的 探讨超声引导下经皮穿刺活检胰占位性病变的诊断和鉴别诊断价值。方法 用 18G (粗针 )及 2 1G(细针 )活检针于超声引导下经皮穿刺 16 3例胰占位性病变 ,所取组织以能作出明确组织病理诊断为取材满意 ,否则为不满意 ,术后病理诊断或随访至少 6个月以上结果为最后诊断。结果 粗针活检 15例 ,平均进针 2 .3次 ;细针活检 14 8例 ,平均进针 3 .2次。组织学检查 15 5例 ,细胞学检查 12 2例 ,组织学加细胞学检查133例。同一部位取材满意率 ,在粗细针间差异无显著性意义 (P >0 .0 5 )。其组织学、细胞学、组织学加细胞学对胰占位性病变的敏感性分别为 95 .2 %、79.8%和 97.4% ,准确率分别为 96 .1%、84.4%和 97.7% ,特异性均为 10 0 %。并发症 3例 ,占 1.8%。结论 超声引导下经皮穿刺胰腺占位性病变活检的敏感性、特异性和准确性高 ,并发症发生率低 ,是临床确诊胰腺占位性病变性质的有效方法。

Objective To investigate the value of percutaneous needle aspiration biopsy(PNAB) under the guidance of ultrasonography in the diagnosis of space-occupying pancreatic lesions(SOPL).Methods One hundred and sixty-three SOPL patients received PNAB under the guidance of sonography using coarse needle(18G, CNAB) or fine needle(21G, FNAB). Satisfactory sampling was defined as the acquired tissue being large enough to give a definite diagnosis, otherwise as a dissatisfactory sampling. The pathologic diagnosis or the results over six months′ follow-up were taken as the final diagnosis.Results The number of patients receiving CNAB and FNAB were 15 and 148,with the mean puncture times of 2.3 and 3.2 , respectively.There was no significant difference in the satisfactory rate of sampling between CNAB and FNAB at the same site (P> 0.05 ). Histologic, cytologic and histocytologic examinations were finished in 155, 122 and 133 cases, their sensitivity in the diagnosis was pancreatic cancer of 95.2% , 79.8% , and 97.4% , respectively,their accuracy was 96.1% , 84.4% ,and 97.7% , respectively, and the specificity was 100% in all methods. Complications occurred in 3 patients ( 1.8% ).Conclusions PNAB under the guidance of ultrasonography is sensitive, specific and accurate in the diagnosis of SOPL with a lower incidence of complication,it is an effective technique in confirming the diagnosis of SOPL.