超声引导经皮穿刺活检对胰腺占位性病变的诊断价值:病例对照研究

Evaluation of Percutaneous Ultrasound-guided Biopsy for Pancreatic Neoplasms:A Case-control Study

目的评估超声引导经皮穿刺活检对胰腺占位性病变的诊断价值及安全性,对比分析细针抽吸活检(fine needle aspiration,FNA)和粗针穿刺活检(core needle biopsy,CNB)的诊断效力。方法回顾性分析2014年1月至2017年4月北京协和医院经影像学检查发现胰腺肿物并接受超声引导下经皮胰腺肿物活检患者的临床资料。按照穿刺方法不同分为FNA和CNB两组,每组随访至少6个月,根据手术病理、重复活检或随访的临床进展确定最终诊断,对比两种活检方法的灵敏度、特异度、阳性预测值、阴性预测值和准确度。结果共160例符合纳入和排除标准的患者入选本研究,其中FNA组95例,CNB组65例,超声引导经皮穿刺活检的总体灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为93.8%、100%、100%、64.0%、94.4%。CNB的灵敏度、阴性预测值和准确度稍高于FNA(94.7%比93.1%,72.7%比57.1%,95.4%比93.7%),但两种方法的灵敏度、特异度、阳性预测值、阴性预测值、准确度差异并无统计学意义。主要并发症2例(1.3%,2/160),包括1例急性胰腺炎和1例穿刺后针道种植。结论超声引导经皮穿刺活检对于胰腺占位性病变是一种有效、安全的诊断方法,FNA和CNB的诊断效力在本研究中差异并不显著。

Objective This study aimed to evaluate the diagnostic value of percutaneous ultrasound-guided(US-guided)biopsy for pancreatic neoplasms,and to compare the evaluation of fine needle aspiration(FNA)and core needle biopsy(CNB).Methods Data of consecutive patients who had percutaneous US-guided biopsies of pancreatic masses for the diagnosis of suspiciously malignant solid pancreatic masses in Peking Union Medical College Hospital between January 2014 and April 2017 were retrospectively analyzed.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy were evaluated based on the biopsy methods(FNA vs.CNB).The final diagnosis was determined according to a combination of follow-up(no shorter than 6 months)imaging,clinical course evaluation,repeated biopsy and/or surgical pathology.Results A total of 160 patients who met the inclusion and exclusion criteria were enrolled in this study,including 95 in the FNA group and 65 in the CNB group.The overall sensitivity,specificity,PPV,NPV,and accuracy of percutaneous US-guided biopsy were 93.8%,100%,100%,64.0%,and 94.4%,respectively.The sensitivity,NPV,and accuracy of the CNB group were higher than those of FNA group(94.7%vs.93.1%,72.7%vs.57.1%,95.4%vs.93.7%),but there was no statistical difference between the two groups.Two cases with major complications(1.3%,2/160)were observed,including one acute pancreatitis and one tumor seeding.Conclusions Percutaneous US-guided biopsy is an effective and safe diagnostic method for pancreatic neoplasms.The current data do not suggest significant differences in the diagnostic efficacy of FNA and CNB.