超声内镜引导下细针穿刺活检术鉴别胰腺囊性病变良恶性的价值

Endoscopic ultrasound guided-fine needle aspiration in differential diagnosis of benign and malignant pancreatic cystic lesions

目的：探讨超声内镜引导下细针穿刺活检术（EUS-FNA）鉴别胰腺囊性病变良恶性的价值。方法：搜集2013年1月~2014年12月行EUS-FNA检查的15例胰腺囊性病变的临床资料,比较单纯超声内镜（EUS）、EUS-FNA鉴别胰腺囊性病变良恶性的准确率、敏感性、特异性、阳性预测值及阴性预测值。结果：15例患者抽取囊液均足够行细胞学、CEA、淀粉酶检查,4例有实性组织的病变均抽吸组织行病理检查,单纯EUS鉴别胰腺囊性病变良恶性的准确率、敏感性、特异性、阳性预测值及阴性预测值分别为66.7%（10/15）、75.0%（6/8）、57.1%（4/7）、66.7%（6/9）、66.7%（4/6）;EUS-FNA鉴别胰腺囊性病变良恶性的准确率、敏感性、特异性、阳性预测值及阴性预测值分别为80%（12/15）、87.5%（7/8）、71.4%（5/7）、77.8%（7/9）、83.3%（5/6）;伴有实性成分的胰腺囊性病变EUS-FNA鉴别其良恶性准确率为100%（4/4）;15例患者术后均未发生并发症。结论：EUS-FNA对胰腺囊性病变良恶性的鉴别有较高的价值,对伴有实性成分的胰腺囊性病变诊断价值更高。

Objective：To assess the value of endoscopic ultrasound gnided-fine needle aspiration （EUS-FNA） in differential diagnosis of benign or malig- nant pancreatic cystic lesions. Methods：Clinical data were collected in 15 patients with pancreatic cystic lesions undergone EUS-FNA examination between January 2013 and December 2014, and findings were compared regarding the accuracy, sensitivity, specificity, positive predictive value（PPV） and negative predictive value（NPV） by simple EUS detection or E US-FNA. Results：Adequate amount of cyst fluid was aspirated in the 15 patients for carcinoembryon- ic antigen （CEA）, cytology and amylase determination, and the tissues obtained in 4 patients with solid tissue lesion received pathological examination. The accuracy, sensitivity, specificity, PPV and NPV by simple EUS were 66.7% （10/15） ,75.0% （6/8）, 57.1% （4/7）, 66.7% （6/9） and 66.7% （4/6） compared to 80% （12/15） ,87.5% （7/8） ,71.4% （5/7） ,77.8% （7/9） and 83.3% （5/6） by EUS-FNA. The accuracy was 100% for patients with presence of solid component in the cyst by EUS-FNA. No complications occurred in all patients after procedure. Conclusion ：EUS-FNA has higher accuracy in differential diagnosis of malignant and benign pancreatic cystic lesions, and the diagnostic accuracy is maximal for cases with pancreatic cystic lesion.