Abstract Abstract Background: EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a...Abstract Abstract Background: EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a benign or a malignant origin. Aims: (1) To identify a combination of EUS criteria that have a sufficient sensitivity and specificity to preclude the need for EUS-FNA and (2) to assess the cost savings derived from a selective EUS-FNA approach. Methods: A total of 144 patients with esophageal carcinoma were prospectively evaluated with EUS. Accuracy of standard (hypoechoic, smooth border, round, or width > 5 mm) and modified (4 standard plus EUS identified celiac lymph nodes, > 5 lymph nodes, or EUS T3/4 tumor) criteria were compared (receiver operating characteristic curves). Resource utilization of two diagnostic strategies, routine (all patients with lymph nodes) and selective EUS-FNA (FNA only in those patients in whom the number of EUS malignant criteria provides a sensitivity and a specificity< 100% ),were compared. Results: Modified EUS criteria for lymph-node staging were more accurate than standard criteria (area under the curve 0.88 vs. 0.78, respectively). No criterion alone was predictive ofmalignancy; sensitivity and specificity reached 100% when a cutoff value of > 1 and > 6 modified criteria were used, respectively. The EUS-FNA selective approach may avoid performing FNA in 61 patients (42% ). Conclusions: Modified EUS lymph-node criteria are more accurate than standard criteria. A selective EUS-FNA approach reduced the cost by avoiding EUS-FNA in 42% of patients with esophageal carcinoma. These results require confirmation in future studies.展开更多
文摘目的探讨磁共振扩散加权成像(diffusion-weighted imaging,DWI)不同表观扩散系数(apparent diffusion coefficient,ADC)值及其变化率对骨肉瘤新辅助化疗(neoadjuvant chemotherapy,NAC)早期疗效的评估价值。材料与方法回顾性分析2019年1月至2022年3月期间在新疆医科大学附属肿瘤医院行NAC的骨肉瘤患者病例23例,在NAC前、化疗4周期后进行常规MRI和DWI检查,分别获得不同ADC值及其变化率等参数值。根据病理组织学Huvos分级法将患者按照化疗疗效分为组织学反应良好组与组织学反应差组,比较两组间的不同ADC值[平均ADC值(ADC_(mean))、最小ADC值(ADC_(min))、单位体积的平均ADC值(ADC_(mean)/V)、单位体积的最小ADC值(ADC_(min)/V)]及其变化率的差异。结果组织学反应良好组化疗前后ADC_(mean)、ADC_(min)、ADC_(mean)/V、ADC_(min)/V差异均有统计学意义,P值均<0.05(分别为0.024、<0.001、0.018、0.046)。组织学反应差组化疗前后ADC_(mean)、ADC_(min)、ADC_(min)/V差异均有统计学意义,P值均<0.05(分别为0.005、<0.001、0.020),ADC_(mean)/V差异无统计学意义(P=0.071,P>0.05)。两组间ADC_(mean)、ADC_(min)、ADC_(mean)/V、ADC_(min)/V的变化率差异均有统计学意义,P值均<0.05(分别为0.047、0.006、0.039、0.015)。经受试者工作特征(receiver operating characteristic,ROC)曲线分析ADC_(min)变化率曲线下面积(area under the curve,AUC)为0.938,高于ADC_(mean)、ADC_(min)/V、ADC_(mean)/V等变化率(AUC分别为0.783、0.767、0.813)。结论不同ADC值及其变化率对骨肉瘤早期疗效评估具有重要价值,ADC_(min)变化率在骨肉瘤疗效预测中具有显著优势。
文摘Abstract Abstract Background: EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a benign or a malignant origin. Aims: (1) To identify a combination of EUS criteria that have a sufficient sensitivity and specificity to preclude the need for EUS-FNA and (2) to assess the cost savings derived from a selective EUS-FNA approach. Methods: A total of 144 patients with esophageal carcinoma were prospectively evaluated with EUS. Accuracy of standard (hypoechoic, smooth border, round, or width > 5 mm) and modified (4 standard plus EUS identified celiac lymph nodes, > 5 lymph nodes, or EUS T3/4 tumor) criteria were compared (receiver operating characteristic curves). Resource utilization of two diagnostic strategies, routine (all patients with lymph nodes) and selective EUS-FNA (FNA only in those patients in whom the number of EUS malignant criteria provides a sensitivity and a specificity< 100% ),were compared. Results: Modified EUS criteria for lymph-node staging were more accurate than standard criteria (area under the curve 0.88 vs. 0.78, respectively). No criterion alone was predictive ofmalignancy; sensitivity and specificity reached 100% when a cutoff value of > 1 and > 6 modified criteria were used, respectively. The EUS-FNA selective approach may avoid performing FNA in 61 patients (42% ). Conclusions: Modified EUS lymph-node criteria are more accurate than standard criteria. A selective EUS-FNA approach reduced the cost by avoiding EUS-FNA in 42% of patients with esophageal carcinoma. These results require confirmation in future studies.
