摘要
Background:Endoscopic ultrasound(EUS)-guided fine needle aspiration(FNA)has become the preferred method to diagnose pancreatic masses due to its minimally invasive approach and diagnostic accuracy.Many studies have shown that rapid on-site evaluation(ROSE)improves diagnostic yield by 10–30%;however,more recent studies have demonstrated effective diagnostic accuracy rates without ROSE.Our study aims to examine whether the current standard of performing ROSE after each FNA pass adds diagnostic value during EUS-guided FNA of pancreatic masses.Methods:We conducted a retrospective case series on patients who underwent EUS-guided FNA of pancreatic masses between February 2011 and October 2014.All cases were performed by one of three endoscopists at Emory University Hospital.Patient demographics,radiologic details of pancreatic masses and pathology reports of the biopsied pancreatic masses were examined.Results:A total of 184 procedures performed in 171 patients were reviewed.The final pathology reports of the biopsied pancreatic masses showed 128(70%)with confirmed malignancy.Only 64(50%)of these 128 cases initially showed malignant cells during ROSE.Among these 64 cases,23%required 5 or more FNA passes to first detect malignant cells.Conclusions:The use of ROSE during EUS-guided FNA of pancreatic masses may increase the diagnostic yield,since malignant cells were often detected during later FNA passes that would otherwise be missed if tissue sampling stopped prematurely.In addition,sample preparation for ROSE may be suboptimal,since malignant cells were only detected in 50%of cases.
背景:内镜超声(EUS)引导下细针穿刺(FNA)凭借其微创性和高准确率,已然成为胰腺肿块的最佳诊断方法。许多研究显示,快速现场评估(ROSE)可以提高10%~30%的诊断率;然而,最近的研究认为,无需ROSE,EUS-FNA亦可获得满意的诊断准确率。本研究旨在评估在每次FNA取材后常规进行ROSE是否可以提高EUS-FNA对胰腺肿块的诊断效能。方法:我们进行了一项回顾性研究,研究对象是2011年2月至2014年10间接受EUS-FNA检查的胰腺肿块患者。所有检查均由Emory大学附属医院三名内镜医生完成,均行ROSE操作。对纳入患者的人口统计资料、胰腺肿块的影像学特征及病理活检报告进行分析。结果:共计171例患者184次EUS-FNA检查纳入分析。最终病理报告证实128例(70%)为恶性肿瘤。128例恶性肿瘤中,只有64例(50%)在ROSE下得到诊断。在这64例中,有23%的ROSE需要5次以上(含5次)的FNA取材才发现恶性细胞。结论:在对胰腺肿块进行EUS-FNA检查中应用ROSE可以提高诊断获益,因为恶性细胞通常在多次FNA取材后才会被发现,过早终止取材容易漏诊。此外,目前针对ROSE的样本准备不甚理想,只有50%的恶性细胞通过ROSE被发现。
