不同细胞病理学分级标准对超声内镜引导下细针穿刺诊断胰腺癌的影响

Effect of different cytopathological grading standards on the diagnosis of pancreatic cancer by endoscopic ultrasound-guided fine needle aspiration

目的探讨不同细胞病理学分级标准对超声内镜引导下细针穿刺(EUS-FNA)诊断胰腺癌效能的影响。方法收集2011年5月—2019年3月于安徽医科大学第一附属医院行EUS-FNA检查的256例胰腺占位患者的临床资料和胰腺细胞病理学诊断结果,以手术病理结果和随访情况作为最终诊断,评估影响EUS-FNA诊断效能的相关因素。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验;计数资料两组间比较采用χ^2检验。应用受试者工作特征曲线(ROC曲线)评价不同细胞病理学分级标准对胰腺癌的诊断价值。结果剔除失访患者67例,共189例患者纳入研究,按巴氏细胞病理学标准,EUS-FNA诊断细胞病理学结果为异型细胞47例,疑癌细胞25例,癌细胞20例,未见肿瘤细胞97例。133例经术后病理和随访结果证实为胰腺癌,其中细胞病理学检查结果分别为:未见肿瘤细胞52例,异型细胞36例,疑癌细胞25例,癌细胞20例。EUS-FNA诊断胰腺癌的真阳性率为60.90%(81例),假阴性率为39.10%(52例);非胰腺癌56例,假阳性率为19.64%(11例),真阴性率为80.36%(45例)。EUS-FNA诊断胰腺癌的ROC曲线下面积为0.643(95%CI:0.561~0.724)。联合不同细胞病理学分级标准,分别以“发现异型细胞或可疑癌细胞或癌细胞均为阳性”“发现可疑癌细胞或癌细胞均为阳性”和“发现癌细胞为阳性”为诊断标准进行分析,结果显示,以“发现异型细胞或可疑癌细胞或癌细胞均为阳性”为诊断标准,EUS-FNA诊断胰腺癌的效能提高,敏感度为50.38%,特异度为75.00%。189例患者EUS-FNA术后并发症发生率为6.88%(13例),主要为高淀粉酶血症和腹痛。结论联合不同细胞病理学分级标准有助于提高EUS-FNA对胰腺癌的诊断效能。

Objective To investigate the effect of different cytopathological grading standards on the efficiency of endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)in the diagnosis of pancreatic cancer.Methods Related clinical data and pancreatic cytopathological results were collected from 256 patients with pancreatic space-occupying lesions who underwent EUS-FNA in The First Affiliated Hospital of Anhui Medical University from May 2011 to March 2019,and the influencing factors for the diagnostic efficiency of EUS-FNA were analyzed based on surgical pathology and follow-up results.The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.The receiver operating characteristic(ROC)curve was used to evaluate the value of different cytopathological grading standards in the diagnosis of pancreatic cancer.Results A total of 67 patients who were lost to follow-up were excluded,and a total of 189 patients were included in the study.According to the Papanicolaou cytopathological standard,there were 47 cases of heterotypic cells,25 cases of suspected cancer cells,20 cases of cancer cells,and 97 cases without tumor cells based on EUS-FNA.A total of 133 patients were confirmed to have pancreatic cancer by postoperative pathology and follow-up results,among whom 52 had no tumor cells,36 had heterotypic cells,25 had suspected cancer cells,and 20 had cancer cells based on cytopathological results.EUS-FNA had a true positive rate of 60.90%(81 patients)and a false negative rate of 39.10%(52 patients)in the diagnosis of pancreatic cancer;for the 56 patients without pancreatic cancer,EUS-FNA had a false positive rate of 19.64%(11 patients)and a true negative rate of 80.36%(45 patients).EUS-FNA had an area under the ROC curve of 0.643(95%confidence interval:0.561-0.724)in the diagnosis of pancreatic cancer.In combination with different cytopathological grading standards and with the diagnostic criteria of“the identification of heterotypic cells or suspected cancer cells or cancer cells was considered positive”,“the identification of suspected cancer cells or cancer cells was considered positive”,and“the identification of cancer cells was considered positive”,the results showed that the diagnostic criteria of“the identification of heterotypic cells or suspected cancer cells or cancer cells was considered positive”improved the efficiency of EUS-FNA in the diagnosis of pancreatic cancer,with a sensitivity of 50.38%and a specificity of 75.00%.Among the 189 patients,13(6.88%)experienced complications after EUS-FNA,which included hyperamylasemia and abdominal pain.Conclusion The combination of different cytopathological grading standards can help improve the efficiency of EUS-FNA in the diagnosis of pancreatic cancer.