讨论EUS-FNA穿刺物的基因检测对胰腺癌诊断价值

胰腺癌属于高度恶性肿瘤的一类,在全世界范围内其发病率都有逐渐升高态势。胰腺癌早期缺乏特异性临床表现,增加了早期诊断难度,并且转移可能性大,确诊时常常已经到了晚期,手术以及放化疗均没有明显效果,预后不佳,所以必须做好胰腺癌的尽早诊断,以保证临床能够尽早实施治疗,帮助预后得到改善。本研究具体探讨EUS-FNA穿刺物中K-ras基因定性检测、定量检测以及miRNA检测对胰腺癌诊断价值。

EUS引导的Trucut细针穿刺活检与EUS引导FNA进行活检补救:一项前瞻性研究

Background: EUS-guided FNA (EUS-FNA) is an accurate technique for sampling extraintestinal masses and lymph nodes. The use of a Trucut needle to perform EUS-guided biopsy (EUS-TCB) may improve the results or simplify the procedure. To date, few studies have prospectively assessed the performance and the safety of EUS-TCB. Methods: Patients with a known or a suspected malignancy referred for a diagnostic and/or staging EUS examination were enrolled in a prospective study. EUS-guided biopsy was performed first with a 19-gauge Trucut needle. If the Trucut failed to obtain an adequate sample orwhen the “ in room" touch preparation was benign, EUS-FNA was performed with a standard 22-gauge FNA needle. The objective of the study was to assess the yield of detection of malignancy and the safety of EUS-TCB in patients with known or suspected malignancies and to investigate if EUS-FNA has a role for rescue in cases of Trucut failure. Observations: Thirty-nine lesions underwent EUS-TCB in 30 patients. Sufficient follow-up was available for all patients. By using EUS-TCB, we were able to obtain a sample for diagnosis in all but 3 patients (one pancreatic mass and two lymph nodes) in which technical problems arose. In these patients, the diagnosis was obtained in two cases by EUS-FNA and in the other one by EUS-TCB from the primary pancreatic tumor. The yield of detection of malignancy for EUS-TCB was 84% . No complications were recorded in any patients at 1 and 7 days of follow-up. The sample size is limited to generalize conclusions. Conclusions: EUS-TCB is a safe and an accurate procedure to obtain a histologic diagnosis in patients with known or suspected malignancies. EUS-FNA can serve as a rescue technique in cases of Trucut failure.

EUS引导下的FNA对于诊断乳腺癌转移至食管和纵隔的价值

Background: Breast cancer can metastasize to the esophagus and the mediastinum . EUS-guided FNA (EUS-FNA) is being used increasingly as a less invasive alter native to mediastinoscopy for procuring a tissue diagnosis of mediastinal diseas e and may be useful for the diagnosis of breast cancer metastatic to the esophagus and the mediastinum. Methods: Twelve women(age range 54-82 years) with a history of breast cancer presented with dy sphagia or other symptoms between 1 and 15 years after initial diagnosis and tre atment. CT and endoscopy with biopsies suggested a mediastinal mass or lymphaden opathy with extrinsic esophageal compression but failed to provide a tissue diag nosis. EUS-FNA was performed for diagnosis.Results: Cytologic evaluation of spe cimens obtained by EUSFNA confirmed breast cancer metastases in 11 of 12 patient s(91%). Recurrent disease was found in intramural masses and periesophageal lym ph nodes. No complication resulted from any EUS-FNA procedure. Conclusions: EUS -FNA is safe and effective for the diagnosis of breast cancer metastases to the esophagus and the mediastinum. EUS-FNA may be useful as a first-line method o f evaluation when breast cancer metastasis to the esophagus and the mediastinum is suspected.

内镜超声引导下细针穿刺的操作技巧

内镜超声引导下的细针穿刺(Endoscopic Ultra-sonography Guided Fine Needle Aspiration,EUS-FNA),是在内镜超声的引导下将穿刺细针或切割针通过内镜管道穿刺入目标组织。

EUS—FNA细胞学检查对胰腺囊性病变良恶性鉴别的荟萃分析

通过内镜超声引导下细针穿刺活检（ endoscopicultrasonography guided fine-needle aspiration, EUS-FNA）获得的细胞学、囊液的生物化学、肿瘤标志物等信息是目前诊断胰腺囊性病变（pancreaticcysticlesions，PCLs）的有效手段之一。最近许多前瞻性研究评估了EUS-FNA的安全性，

利普液基细胞学(LPT)技术联合肿瘤标志物检测在甲状腺细针穿刺(FNA)中的临床应用价值

目的:探讨甲状腺细针穿刺(FNA)中利普液基细胞学(LPT)技术联合肿瘤标志物检测在的临床应用价值。方法:将我院2016年8月至2018年8月期间的76例甲状腺细针穿刺(FNA)患者进行研究,对所有标本均采用利普液基细胞学(LPT)技术联合肿瘤标志物检测以及传统涂片进行检测,分析检测结果。结果:相对于传统涂片来说,利普液基细胞学(LPT)技术可获得更多的细胞数量,且细胞均呈单层,分布均匀,结构较为清晰,且图片的背景较为干净,诊断准确率明显高于传统涂片。结论:相对于传统涂片来说,利普液基细胞学(LPT)技术可有效提高诊断准确率以及甲状腺细针穿刺(FNA)标本制片的质量,所以在甲状腺癌以及甲状腺癌前病变的诊断以及筛查中可运用利普液基细胞学(LPT)技术联合肿瘤标志物检测。

超声内镜的并发症

美国消化内镜学会（ASGE）最近发表了有关超声内镜并发症的临床指南。超声内镜（EUS）和EUS引导的细针穿刺（EUS—FNA）日益成为准确和安全的消化道和非消化道恶性肿瘤的诊断和分期手段。EUS—FNA还被用于以治疗和诊断为目的的液体收集和囊性病变的液体抽吸。EUS和EUS—FNA并发症的发生率和类型与其他内镜操作有所不同。2005年1月，在ASGE发布的临床指南中，研究者们讨论了EUS和EUS—FNA有关的并发症发生情况和处理建议。

内镜超声引导下细针穿刺活检对上消化道及毗邻脏器疾病的诊断价值

目的 探讨纵轴内镜超声引导下细针穿刺活检 (EUS FNA)在上消化道及其毗邻脏器疾病诊断中的价值。方法 3 1例上消化道及其毗邻脏器疑难疾病患者行纵轴EUS FNA ,进行细胞学及组织学检查初步诊断。所有患者均随访 6个月或经手术病理作出最终诊断。评价纵轴EUS FNA诊断准确性。结果 2 5例患者获得足够的细胞或组织学资料 ,穿刺成功率 80 .6%。在所有穿刺病例中 ,EUS FNA敏感性 81.5 % ,特异性10 0 % ;而在穿刺成功的病例中 ,敏感性达到 90 .5 % ,特异性 10 0 %。所有患者未出现严重并发症。结论 纵轴EUS FNA对上消化道及其毗邻脏器疾病的诊断特异性高 ,尤其对常规方法诊断困难的部分疾病价值较大。提高穿刺成功率和小病变穿刺准确性是增进其临床价值的关键。

影响内镜超声引导细针抽吸术结果的因素分析

内镜超声引导细针抽吸术（EUS—FNA）自1992年首次报告在对胰腺进行细针穿刺以来，已被广泛应用于消化道及其周围病变的诊断，与传统腹部超声或CT引导下的经皮穿刺细针抽吸术相比，EUS-FNA具有穿刺距离短、安全性高等优点，目前已成为对各种消化系良、恶性疾病进行鉴别或分期的一种成熟的微创性介入诊断内镜技术。虽然EUS—FNA能取得很好的诊断准确率，但其结果仍存在较高的假阴性率，因此，如何提高EUS—FNA的诊断准确性是从事超声内镜工作的医师们共同关注的问题，故本文旨在对影响EUS—FNA结果的诸多因素进行归纳综述。