超声内镜引导下细针抽吸术中辅助弹性成像的诊断价值

Diagnostic value of assisted elastography in endoscopic ultrasound-guided fine needle aspiration

目的探讨超声内镜弹性成像(endoscopic ultrasound elastography,EUS-E)辅助超声内镜引导下细针抽吸术(endoscopic ultrasound-guided fine needle aspiration,EUS-FNA)诊断上消化道周围恶性占位性病变的应用价值。方法回顾性分析2020年1月—2021年4月在宁夏医科大学总医院成功完成EUS-FNA的54例患者(57个病灶)的临床资料,依据完成FNA时是否辅助使用EUS-E分为EUS-E组和非EUS-E组,其中2020年5月—2021年2月完成FNA的30例患者(31个病灶)在行FNA时均辅助使用EUS-E,为EUS-E组,其余24例患者(26个病灶)在行FNA时未辅助使用EUS-E,进行常规EUS-FNA,为非EUS-E组。评估EUS-FNA诊断效能,比较EUS-E组和非EUS-E组的诊断效能。分析EUS-E组中患者的EUS-E评分。结果EUS-FNA诊断消化道周围恶性占位性病变的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为80.5%(33/41)、100.0%(16/16)、100.0%(33/33)、66.7%(16/24)和86.0%(49/57)。EUS-FNA在胰腺和其他部位(纵隔和腹腔)恶性占位性病变诊断中的敏感度[78.6%(22/28)比84.6%(11/13),P=0.232]和准确率[83.8%(31/37)比90.0%(18/20),P=0.156]比较差异无统计学意义。术后1例(1.85%,1/54)患者出现并发症。EUS-E组中EUS-FNA诊断消化道周围恶性占位性病变的敏感度[84.0%(21/25)比81.3%(13/16),P=0.186]和准确率[87.1%(27/31)比88.5%(23/26),P=0.186]与非EUS-E组相比差异无统计学意义。EUS-E组EUS-E评分≥3分预测恶性占位与最终诊断一致性较强(Kappa=0.63)。结论EUS-FNA是一项安全有效的细胞组织病理诊断手段,在诊断上消化道周围占位性病变中起重要作用。EUS-E评分能很好地预测占位病变良恶性,但EUS弹性靶向FNA在诊断敏感度和准确率上未表现出优势。

Objective To investigate the diagnostic value of endoscopic ultrasound elastography(EUS-E)in endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)for malignant occupying lesions in gastrointestinal adjacent tissue.Methods Clinical data of 54 patients(57 lesions)undergoing EUS-FNA from January 2020 to April 2021 in the General Hospital of Ningxia Medical University were collected.Thirty patients(31 lesions)who received FNA assisted by EUS-E from May 2020 to February 2021 were enrolled in the EUS-E group,and 24 patients(26 lesions)who underwent routine EUS-FNA without EUS-E in the non-EUS-E group.The diagnostic efficacy of EUS-FNA was evaluated.The diagnostic efficacy of EUS-E group and non EUS-E group was compared.EUS-E score of EUS-E group was analyzed.Results The overall sensitivity,specificity,positive predictive value,negative predictive value and accuracy of EUS-FNA in the diagnosis of malignant occupying lesions in gastrointestinal adjacent tissue were 80.5%(33/41),100.0%(16/16),100.0%(33/33),66.7%(16/24)and 86.0%(49/57),respectively.There were no significant differences in sensitivity[78.6%(22/28)VS 84.6%(11/13),P=0.232]or accuracy[83.8%(31/37)VS 90.0%(18/20),P=0.156]of EUS-FNA for pancreatic lesions and other lesions(mediastinal and celiac lesions).Postoperative complications occurred in 1 patient(1.85%,1/54).Also there were no significant differences in sensitivity[84.0%(21/25)VS 81.3%(13/16),P=0.186]or accuracy[87.1%(27/31)VS 88.5%(23/260,P=0.186]of diagnosis of malignant occupying lesions between EUS-E group and non-EUS-E group.In the EUS-E group,EUS-E score≥3 was highly consistent with the definite diagnosis(Kappa=0.63).Conclusion EUS-FNA is a safe and effective cytological and pathological method for diagnosis in gastrointestinal adjacent tissue.EUS-E score can well predict benign and malignant lesions,but EUS-FNA assisted by EUS-E does not show superiority in diagnostic sensitivity or accuracy.