超声内镜引导下穿刺活检对常规胃镜活检阴性病灶的诊断价值

Role of endoscopic ultrasound(EUS)-guided targeted biopsy in conventional endoscopic biopsy negative lesions

目的评估超声内镜(endoscopic ultrasound,EUS)引导下穿刺活检对常规胃镜活检阴性的食管、胃疾病的诊断有效性及安全性。方法本研究分析了2016年5月至2018年7月本院接诊的可疑存在食管、胃恶性肿瘤但常规胃镜活检阴性的患者进行超声内镜和超声内镜引导下穿刺活检的病理结果和随访情况,以病理结果和(或)随访情况为最终诊断,评价超声引导下穿刺活检的诊断价值。结果共16例患者纳入研究,16例患者中有8例(50%)穿刺活检病理明确诊断为恶性肿瘤(分别为3例食管鳞癌、2例胃腺癌、1例非霍奇金B细胞淋巴瘤、1例胃间质瘤,1例发现淋巴管内癌栓);有3例患者发现可疑异型细胞,怀疑为恶性肿瘤(其中2例在随访时确诊为胃癌),剩余的5例患者穿刺病理考虑为炎性改变,与后续的手术病理和(或)随访结果一致。超声内镜引导下穿刺活检的灵敏度为100%,特异度为83.3%,阳性预测值为90.9%,阴性预测值为100%,符合率为93.8%,EUS引导下穿刺活检与最终诊断比较,总体一致性好(Kappa值0.86),无穿刺相关合并症。结论超声内镜引导下穿刺活检对提高常规胃镜活检阴性病灶的诊断率有效、安全,对于普通胃镜活检未能获得有效病理学依据的病变,推荐进行超声内镜引导下穿刺活检。

Objective To evaluate the efficacy and safety of endoscopic ultrasound(EUS)-guided biopsy in the diagnosis of underlying malignancy in patients with suspicious esophageal and gastric cancer and negative mucosal biopsies.Methods A retrospective analysis was conducted in sixteen patients who have suspicious esophageal and gastric cancer but endoscopic biopsy was negative.EUS and EUS-guided biopsy were performed to all those patients from May 2016 to July 2018 in our hospital.Results Sixteen patients(5 male)aged 29-83 years[median(53.19±16.98)years]were included in this study.Malignancy was confirmed in 8/16 patients on histology,suspicious tumor cells were found in 3/16 patients(2 of the three patients were finally diagnosed as malignant tumor).The remaining five patients were diagnosed with benign diseases.EUS-guided biopsy showed a sensitivity of 100%,specificity of 83.3%,positive predictive value(PPV)of 90.9%,negative predictive value(NPV)of 100%and accuracy of 93.8%.The consistency of EUS-guided biopsy and final diagnosis was great(Kappa=0.86).There were no immediate or late complications.Conclusion EUS-guided targeted biopsy is a helpful and safe procedure in the diagnosis of esophageal and gastric tumors with negative endoscopic biopsies.