EUS-FNA对胰腺癌的诊断价值及漏诊的相关危险因素分析

Diagnostic Value of EUS-FNA for Pancreatic Cancer and Analysis of Related Risk Factors for Missed Diagnosis

目的探讨超声内镜引导下细针穿刺对胰腺癌的诊断价值,分析其漏诊的相关危险因素。方法选取2016年9月-2018年7月某院经胰腺手术治疗后病理学检查证实的胰腺癌患者82例作为胰腺癌组,40例胰腺良性肿瘤患者作为对照组,所有患者术前均接受了EUS-FNA检查,以术后病理学结果作为金标准,分析EUS-FNA对胰腺癌的诊断价值,同时分析其对胰腺癌漏诊的影响因素。结果 EUS-FNA诊断胰腺癌的灵敏度为80.49%,特异度为100.00%,漏诊率为19.51%,误诊率为0。EUS-FNA诊断胰腺癌漏诊患者病灶直径≤2cm、肿瘤位于胰腺体尾部、肿瘤未发生血管侵犯、肿瘤分期为Ⅰ期者所占比例均明显高于EUS-FNA确诊的胰腺癌患者,差异均有统计学意义(P<0.05);而EUS-FNA确诊和漏诊患者在年龄、性别、肿瘤分化程度方面差异无统计学意义(P>0.05)。Logistic回归分析结果显示:病灶直径≤2cm、肿瘤位于胰腺体尾部、肿瘤未发生血管侵犯是EUS-FNA诊断胰腺癌发生漏诊的独立危险因素(P<0.05)。结论 EUS-FNA对胰腺癌诊断的灵敏度不高,但是特异度很高,EUS-FNA对胰腺癌的漏诊主要受病灶大小、肿瘤部位以及是否发生血管侵犯的影响。

Objectives To evaluate the diagnostic value of ultrasound-endoscope-guided fine-needle puncture for pancreatic cancer and analyze the risk factors of missed diagnosis. Methods To select 82 cases of patients with pancreatic cancer confirmed by the pathology examination after pancreatic surgery from September 2016 to July 2018 in a hospital as pancreatic cancer group, 40 cases of pancreatic benign tumors patients as control group, all patients with preoperative underwent EUS FNA-check, results in postoperative pathology as the gold standard, analysis of EUS FNA-value to the diagnosis of pancreatic cancer, and analyze the influence factors of pancreatic cancer diagnosis. Results EUS-FNA had a sensitivity of 80.49%, specificity of 100.00%, missed diagnosis rate of 19.51%, and misdiagnosis rate of 0. EUS FNA-diameter 2 cm or less diagnosis in diagnosis of pancreatic cancer patients with lesions, tumor located in the pancreatic tail, tumor without vascular invasion, tumor staging for Ⅰ period were significantly higher than the proportion of EUS FNA-diagnosis of pancreatic cancer patients, differences were statistically significant(P<0.05);EUS-FNA diagnosis and missed diagnosis had no significant difference in age, gender or tumor differentiation(P>0.05). Logistic regression analysis showed that: the diameter of the lesion was 2 cm, the tumor was located at the tail of the pancreas, and the tumor did not have vascular invasion, which was an independent risk factor for EUS-FNA in the diagnosis of pancreatic cancer(P<0.05). Conclusions EUS-FNA had low sensitivity but high specificity in the diagnosis of pancreatic cancer, and the missed diagnosis of pancreatic cancer was mainly affected by the size of the lesion, tumor site and whether vascular invasion occured.