超声引导下粗针穿刺活组织病理学检查诊断胰腺占位性病变的临床应用价值

Clinical study of ultrasonography guided percutaneous core needle biopsy in pancreatic lesions

目的评价超声引导下粗针穿刺活组织病理检查诊断胰腺占位性病变的临床应用价值。方法 2012年2月至2013年11月上海交通大学附属第一人民医院收治34例胰腺占位性病变患者,共36个病灶。应用18 G粗针和自动活检枪对所有患者行常规超声引导下穿刺,并记录病灶部位、大小、病灶周边及内部血管分布、穿刺针数、取材是否满意等,所取组织标本行病理学检查,并与临床最终诊断结果进行对比。结果 32个病灶穿刺2针,2个病灶穿刺3针,2个病灶穿刺4针,平均穿刺(2.17±0.51)针。本组穿刺取材满意率为89%(32/36)。36个胰腺占位性病灶穿刺活组织病理学检查结果为:胰腺恶性肿瘤31个,包括导管腺癌27个,淋巴瘤2个,小细胞神经内分泌癌、子宫平滑肌肉瘤转移各1个;非恶性肿瘤5个,包括良性病变3个,不典型增生、肉芽组织各1个。本组36个胰腺占位性病灶临床最终诊断为胰腺恶性肿瘤34个,非恶性肿瘤2个。超声引导下粗针穿刺活组织病理检查诊断胰腺占位性病变的敏感度为91%(31/34),特异度为100%(2/2),准确性为92%(33/36),阳性预测值为100%(31/31),阴性预测值为40%(2/5),约登指数为0.91。2例患者术后出现轻微上腹部疼痛,1例患者术后出现一过性血淀粉酶浓度升高,无胰腺炎、胰瘘、腹膜炎、出血或肿瘤沿针道种植等严重并发症。结论超声引导下粗针穿刺活组织病理检查是一种简便快速、安全有效地诊断胰腺占位性病灶的方法。

Objective To evaluate the clinical value of ultrasonography guided percutaneous core needle biopsy in pancreatic lesions. Methods Thirty-four patients with 36 pancreatic lesions in Shanghai First People′s Hospital Afifliated to Shanghai Jiao Tong University from February 2012 to November 2013 underwent conventional ultrasound-guided percutaneous core needle biopsy using automatic gun and 18-gauge biopsy needles. The site, size, internal and surrounding vascularity, the sampling number of the lesions, and whether the specimens′ quality was satisfied were recorded. Then specimens were sent for pathological examination, and all above observations were compared with the ifnal diagnosis. Results The number of lesions with 2, 3 and 4 samplings was 32, 2 and 2, respectively. The average number of sampling was 2.2 （mean, 2.17;standard deviation, 0.51） and the acquisition rate of satisifed specimens was 89%（32/36）. The pathological results of biopsy were malignant in 31 of 36 lesions including 27 cases of ductal adenocarcinoma, 2 cases of lymphoma, 1 case of small cell neuroendocrine carcinoma and 1 case of uterine leiomyosarcoma metastasis. The other 5 lesions were non-malignant including 3 cases of benign lesion, 1 cases of atypical hyperplasia and 1 cases of granulation tissue. The 36 lesions were ifnally diagnosed as 34 cases of pancreatic malignancy, 2 cases of non-malignant neoplasm. The sensitivity, speciifcity, accuracy, positive predictive value and negative predictive value of ultrasonography guided percutaneous core needle biopsy in pancreatic lesions were 91%（31/34）, 100%（2/2）, 92%（33/36）, 100%（31/31） and 40%（2/5）, respectively. Youden index was 0.91. Two patients had mild upper abdominal pain and 1 patient had transient elevated serum amylase. No pancreatitis, pancreatic fistula, peritonitis, bleeding or dispersion of malignant cells along the penetrating channel or other serious complications occurred. Conclusion Ultrasonography guided percutaneous core needle biopsy is a simple, rapid, safe and effective diagnostic method in pancreatic lesions with high clinical value.