EUS-FNA在胰腺肿瘤中的诊断价值

The diagnostic value of EUS-FNA in pancreatic tumors

目的分析超声内镜引导下细针穿刺活检(EUS-FNA)诊断胰腺肿瘤的价值。方法筛选2017年1月至2019年1月河南大学第一附属医院行EUS-FNA检查的可疑胰腺占位性病变44例,以病理结果为金标准,分析EUS-FNA鉴别胰腺肿瘤良恶性的价值,评估其诊断效能。结果 (1)EUS-FNA检出恶性27例,良性17例,诊断灵敏度为92.00%,特异性为78.94%,准确率为86.36%,阳性预测值为85.19%,阴性预测值为88.23%,与金标准一致性Kappa值为0.718;(2)良性胰腺肿块病灶最大直径短于恶性胰腺肿块,病灶为囊性结构所占比例、边界清晰比例高于恶性患者(P<0.05);(3)EUS-FNA确诊胰腺实性肿瘤28例(93.33%),胰腺囊肿8例(72.73%),其他2例(66.67%),EUS-FNA对胰腺实性肿瘤诊断灵敏度、特异度、准确率分别为95.83%、83.33%和93.33%,对胰腺囊性病变诊断灵敏度、特异度、准确率分别为75.00%、71.43%和72.73%,对其他诊断灵敏度、特异度、准确率分别为50.00%、100.00%和66.67%。结论 EUS-FNA鉴别良恶性胰腺肿瘤与手术病理一致性高,尤其对实性肿瘤诊断价值高,对囊性肿瘤价值偏低,组织取材对EUS-FNA诊断准确率有较大的影响。

Objective To analyze the value of endoscopic ultrasonography guided fine-needle aspiration(EUS-FNA)in the diagnosis of pancreatic tumors.Methods Forty-four patients with suspected pancreatic space-occupying lesions who underwent EUS-FNA in the First Affiliated Hospital of Henan University from January 2017 to January 2019 were screened.With surgical pathological findings as the golden standard,the value of EUS-FNA in the differential diagnosis of benign and malignant pancreatic tumors was evaluated,and its diagnostic efficiency was evaluated.Results①EUS-FNA detected malignant lesions in 27 cases and benign lesions in 17 cases.The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value was 92.00%,78.94%,86.36%,85.19%and 88.23%,respectively.The kappa value was 0.718.②The largest diameter of benign pancreatic masses was shorter than that of malignant pancreatic masses.The proportions of lesions with cystic structures and clear boundaries were higher than those in patients with malignant lesions(P<0.05).③EUS-FNA confirmed 28 cases(93.33%)of solid pancreatic tumors,8 cases(72.73%)of pancreatic cysts and 2 other cases(66.67%).The diagnostic sensitivity,specificity and accuracy of EUS-FNA for solid pancreatic tumors was 95.83%,83.33%and 93.33%,respectively.The diagnostic sensitivity,specificity and accuracy for pancreatic cysts was 75.00%,71.43%and 72.73%,respectively.The diagnostic sensitivity,specificity and accuracy for other lesions was 50.00%,100.00%and 66.67%,respectively.Conclusions EUS-FNA is highly consistent with surgical pathology in the diagnosis of benign and malignant pancreatic tumors,especially for solid tumors.The diagnostic value for cystic tumors is relatively lower.Tissue extraction has a significant impact on the diagnostic accuracy of EUS-FNA.