Concise review on the comparative efficacy of endoscopic ultrasound-guided fine-needle aspiration vs core biopsy in pancreatic masses, upper and lower gastrointestinal submucosal tumors

Endoscopic ultrasound(EUS)-guided fine needle aspiration with or without biopsy(FNA/FNB) are the primary diagnostic tools for gastrointestinal submucosal tumors. EUS-guided fine needle aspiration(EUS-FNA) is considered a first line diagnostic method for the characterization of pancreatic and upper gastrointestinal lesions, since it allows for the direct visualization of the collection of specimens for cytopathologic analysis. EUSFNA is most effective and accurate when immediate cytologic assessment is permitted by the presence of a cytopathologist on site. Unfortunately, the accuracy and thus the diagnostic yield of collected specimens suffer without this immediate analysis. Recently, a EUS-FNB needle capable of obtaining core samples(fine needle biopsy, FNB) has been developed and has shown promising results. This new tool adds a new dimension to the diagnostic and therapeutic utility of this technique. The aim of the present review is to compare the efficacy of EUS-FNA to that afforded by EUS-FNB in the characterization of pancreatic masses and of upper and lower gastrointestinal submucosal tumors.

Diagnostic utility of endoscopic ultrasound-guided fineneedle aspiration biopsy for glomus tumor of the stomach

A 52-year-old man was referred for further investigation of a gastric submucosal tumor on the greater curvature of the antrum. Endoscopic ultrasonography demonstrated a hypoechoic solid mass, which was primarily connected to the muscular layer of the stomach. We performed endoscopic ultrasoundguided fine-needle aspiration biopsy. The pathological examination showed proliferation of oval-shaped cells with nest formation, which stained strongly positive for muscle actin, and negative for c-kit, CD34, CD56,desmin, S-100, chromogranin, and neuron-specific enolase. Therefore, we performed laparoscopy and endoscopy cooperative surgery based on the preoperative diagnosis of glomus tumor of the stomach. The final histological diagnosis confirmed the preoperative diagnosis. Although preoperative diagnosis of glomus tumor of the stomach is difficult with conventional images and endoscopic biopsy, endoscopic ultrasoundguided fine-needle aspiration biopsy is an essential tool to gain histological evidence of glomus tumor of the stomach for early diagnosis.

Fine needle aspiration diagnosis of isolated pancreatic tuberculosis: A case report

Tuberculosis(TB) involving the pancreas are uncommon, especially when present in immunocompetent hosts. Pancreatic TB is more frequently associated with miliary TB or widely disseminated disease. Pancreatic TB may present as cystic or solid pancreatic masses, pancreatic abscess or acute or chronic pancreatitis. Majority of the cases are diagnosed after surgical exploration for presumed pancreatic malignancy and preoperative diagnosis is quite difficult. However, improvement in imaging techniques and the resulting imageguided interventions gradually can obviate the need for more invasive diagnostic surgical procedures and expedite the planning of therapy. Herein, we report a rare case of isolated pancreatic TB which presented with pancreatic mass lesion in an immunocompetent host. Diagnosis was made by contrast enhanced computed tomography and guided fine needle aspiration of the pancreatic mass which revealed acid-fast bacillion Ziehl-Neelsen stain. The case was treated successfully with antituberculous drugs. Pancreatic tuberculosis should be considered in the differential diagnosis of a pancreatic mass when the patient is young, residing in the endemic zone of tuberculosis. Every attempt should be made to diagnose the cases to prevent unnecessary operation.

Biopsy of parotid masses:Review of current techniques

Definitive diagnosis of parotid gland masses is required optimal management planning and for prognosis. There is controversy over whether fine needle aspiration cytology(FNAC) or ultrasound guided core biopsy(USCB) should be the standard for obtaining a biopsy. The aim of this review is to assess the current evidence available to assess the benefits of each technique and also to assess the use of intra-operative frozen section(IOFS). Literature searches were performed using pubmed and google scholar. The literature has been reviewed and the evidence is presented. FNAC is an accepted and widely used technique. It has been shown to have variable diagnostic capabilities depending on centres and experience of staff. USCB has a highly consistent diagnostic accuracy and can help with tumour grading and staging. However, the technique is more invasive and there is a question regarding potential for seeding. Furthermore, USCB is less likely to be offered as part of a one-stop clinic. IOFS has no role as a first line diagnostic technique but may be reserved as an adjunct or for lesions not amenable to percutaneous biopsy. On balance, USCB seems to be the method of choice. The current evidence suggests it has superior diagnostic potential and is safe. With time, USCB is likely to supplant FNAC as the biopsy technique of choice, replicating that which has occurred already in other areas of medicine such a breast practice.

Influence of the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guided fine-needle aspiration for resectable pancreatic cancer on clinical performance

AIM:To evaluate the safety and diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)in a cohort of pancreatic cancer patients.METHODS:Of 213 patients with pancreatic cancer evaluated between April 2007 and August 2011,82were thought to have resectable pancreatic cancer on the basis of cross-sectional imaging findings.Of these,54 underwent EUS-FNA before surgery(FNA+group)and 28 underwent surgery without preoperative EUSFNA(FNA-group).RESULTS:All 54 lesions were visible on EUS,and all54 attempts at FNA were technically successful.The diagnostic accuracy according to cytology and histology findings was 98.1%(53/54)and 77.8%(42/54),respectively,and the total accuracy was 98.1%(53/54).One patient developed mild pancreatitis after EUS-FNA but was successfully treated by conservative therapy.No severe complications occurred after EUS-FNA.In the FNA+and FNA-groups,the median relapse-free survival(RFS)was 742 and 265 d,respectively(P=0.0099),and the median overall survival(OS)was1042 and 557 d,respectively(P=0.0071).RFS and OS were therefore not inferior in the FNA+group.These data indicate that the use of EUS-FNA did not influence RFS or OS,nor did it increase the risk of peritoneal recurrence.CONCLUSION:In patients with resectable pancreatic cancer,preoperative EUS-FNA is a safe and accurate diagnostic method.

Endoscopic ultrasound guided fine needle tissue acquisition:Where we stand in 2013?

Since its introduction,endoscopic ultrasound(EUS)guided fine needle aspiration and fine needle biopsy have become an indispensable tool for the diagnosis of lesions within the gastrointestinal tract and surrounding organs.It has proved to be an effective diagnostic method with high accuracy and low complication rates.Several factors can influence the accuracy and the diagnostic yield of this procedure including experience of the endosonographer,availability of onsite cytopathology services,the method of cytopathology preparation,the location and physical characteristics of the lesion,sampling techniques and the type and size of the needle used.In this review we will outline the recent studies evaluating EUS-guided tissue acquisition and will provide practical recommendations to maximize tissue yield.

Is there a difference between 19G core biopsy needle and 22G core biopsy needle in diagnosing the correct etiology?——A meta-analysis and systematic review

AIM To compare the accuracy of endoscopic ultra-sonography(EUS) 19 G core biopsies and 22 G core biopsies in diagnosing the correct etiology for a solid mass.METHODS Articles were searched in Medline, Pub Med, and Ovid journals. Pooling was conducted by both fixed and random effects models. RESULTS Initial search identified 4460 reference articles for 19 G and 22 G, of these 670 relevant articles were selected and reviewed. Data was extracted from 6 studies for 19G(n = 289) and 16 studies for 22G(n = 592) which met the inclusion criteria. EUS 19 G core biopsies had a pooled sensitivity of 91.6%(95%CI: 87.1-95.0) and pooled specificity of 95.9%(95%CI: 88.6-99.2), whereas EUS 22 G had a pooled sensitivity of 83.3%(95%CI: 79.7-86.6) and pooled specificity of 64.3%(95%CI: 54.7-73.1). The positive likelihood ratio of EUS 19 G core biopsies was 9.08(95%CI: 1.12-73.66) and EUS 22 G core biopsies was 1.99(95%CI: 1.09-3.66).The negative likelihood ratio of EUS 19 G core biopsies was 0.12(95%CI: 0.07-0.24) and EUS 22 G core biopsies was 0.25(95%CI: 0.14-0.41). The diagnostic odds ratio was 84.74(95%CI: 18.31-392.26) for 19 G core biopsies and 10.55(95% CI: 3.29-33.87) for 22 G needles. CONCLUSION EUS 19 G core biopsies have an excellent diagnostic value and seem to be better than EUS 22 G biopsies in detecting the correct etiology for a solid mass.

超声弹性成像联合US-FNAB诊断TI-RADS 4类甲状腺结节的价值探讨

目的:探讨超声弹性成像(UE)联合超声引导下细针穿刺活检(US-FNAB)对甲状腺影像报告与数据系统(TI-RADS)4类甲状腺结节的诊断价值。方法:回顾性分析2021年1月至2023年3月于我院手术切除的96例术前超声分类为TI-RADS 4类甲状腺结节患者的临床资料,患者术前均接受UE和US-FNAB检查;以术后病理结果为金标准,使用Kappa一致性检验评价UE、US-FNAB联合诊断TI-RADS 4类甲状腺结节良、恶性的价值。结果:经术后病理证实共有恶性结节68例(70.83%),良性结节28例(29.17%);恶性结节和良性结节的弹性评分分布有统计学差异(P<0.05);术前UE诊断恶性结节59例,良性结节37例;术前US-FNAB诊断恶性结节66例,良性结节30例;UE、US-FNAB、UE联合US-FNAB串联试验诊断结节良、恶性与病理结果一致性一般(Kappa=0.608、0.704、0.492),UE联合US-FNAB并联试验诊断结节良、恶性与病理结果一致性较好(Kappa=0.761)。结论:术前UE联合US-FNAB(并联试验)对TI-RADS 4类甲状腺结节的诊断具有高度敏感性,有助于减少甲状腺癌的漏诊。

Surgical Experience in the Management of 125 Patients with Thyroid Masses in Kashmir

Results of surgical treatment in 125 patients with thyroid masses who attended to a Unit of the Department of ENT, Head and Neck Surgery of Govt. Medical College associated SMHS Hospital Srinagar in the first decade of this century are presented. Age of the patients ranged from 17 to 68 years peaking in the fourth decade of life (Figure 1 and Figure 2). Near 85% of the patients with thyroid masses were female and most of the cases (76%) euthyroid at the time of presentation. Depending upon the expertise of the pathologist, the FNA cytology has a good role in the preoperative diagnosis of thyroid masses especially the malignant types (Figure 3 and Figure 4). The specificity of FNA cytology in detecting malignant thyroid tumors in this study was 100% and the sensitivity was 73.08%. The overall diagnostic accuracy was 83.20%. 45.60% of the thyroid masses proved on excision biopsy to be malignant of which papillary carcinoma continued to be the most common malignant thyroid tumor followed by the medullary, the follicular and the undifferentiated types. Radionuclide scanning gave equivocal results in distinguishing between the benign and the malignant thyroid nodules in this study, but it was useful in evaluating indeterminate cases of FNA cytology. Magnetic resonance imaging of neck was used as an adjunctive imaging modality in assessing the extent of the primary malignant thyroid lesion, its direct extra-thyroidal spread and regional nodal metastases (Figure 5 and Figure 6). Different surgical techniques utilized in dealing with the thyroid masses included partial thyroidectomies and total thyroidectomy with or without modified neck dissection and the results are discussed.

免疫组织化学在甲状腺结节诊断中的运用

目的探讨免疫组织化学在甲状腺结节诊断中的作用。方法回顾性分析2016年1月至2019年12月于杭州市中医院行甲状腺细针穿刺活检的526例甲状腺结节标本,其中结节性甲状腺肿98例,桥本甲状腺炎30例,甲状腺腺瘤198例,甲状腺乳头状癌(papillary thyroid cancer,PTC)200例。免疫组织化学采用抗体包括MC、cyclin D1、CD56、TTF-1。观察此免疫组织化学组合在甲状腺良性病变与PTC间的表达差异。结果PTC与甲状腺良性病变的TTF-1表达比较差异无统计学意义(P>0.05)。PTC的CD56表达显著低于甲状腺良性病变(P<0.001),PTC的MC、cyclin D1表达均显著高于甲状腺良性病变(P<0.001)。MC、CD56、cyclin D1联合诊断PTC的敏感度84.5%,特异性99.1%,阳性预测值98.5%,阴性预测值90.4%。PTC患者的TTF-1、CD56、MC、cyclin D1表达在不同性别、年龄、肿瘤大小、N分期、M分期比较,差异均无统计学意义(P>0.05)。结论免疫组织化学MC、cyclin D1、CD56、TTF-1组合是术前鉴别甲状腺结节性质准确有效的方法,具有重要的临床病理诊断作用。

超声引导下细针穿刺活检对甲状腺结节诊断效能分析

目的探讨彩色多普勒超声检查方法与超声引导下细针穿刺活检检测甲状腺结节的诊断效能。方法选取2020年10月至2021年10月于浙江衢化医院经病理检查诊断为单发甲状腺结节的患者96例,所有患者均行彩色多普勒超声检查及超声引导下细针穿刺活检,以手术组织病理学结果为金标准,比较彩色多普勒超声检查及超声引导下细针穿刺活检的诊断效能。结果彩色多普勒超声检查出良性53例、恶性10例,超声引导下细针穿刺检查出良性65例、恶性18例。细针穿刺活检的准确率、敏感度、特异性分别为86.46%、72.00%、91.55%,显著高于彩色多普勒超声的65.63%、40.00%、74.64%(P<0.05)。结论超声引导下细针穿刺对于诊断甲状腺结节良恶性的结果更为准确,可作为临床上鉴别甲状腺结节良恶性的依据。

高频超声、超声引导下细针穿刺活检(US-FNAB)在甲状腺乳头状癌(PTMC)诊断中的应用价值

目的 探讨在甲状腺乳头状癌(PTMC)患者临床诊断中应用高频超声、超声引导下细针穿刺活检(US-FNAB)的价值。方法 对我院2020年4月至2022年4月收治的PTMC患者95例临床资料实施回顾性分析,纳入的95例PTMC患者共152个结节,其中包括99个PTMC结节和53个甲状腺良性结节(BTN),将PTMC结节者纳入a组,BTN结节者纳入b组,所有患者均实施高频超声、US-FNAB检查,应用χ~2检验和Logistic多因素回归分析不同结节呈现出的超声影像学表现、颈部淋巴结是否可以探及等与PTMC之间的关系,并将术后病理学诊断结果 作为金标准,观察高频超声、US-FNAB在PTMC临床诊断中的应用价值,分析并比较不同诊断方式的准确度、灵敏度以及特异度。结果 a组和b组不同超声征像均存在一定差异,差异有统计学意义(P<0.05);高频超声、USFNAB检查与术后病理学诊断结果 之间具有良好的一致性,高频超声诊断Kappa值为0.801,US-FNAB诊断Kappa值为0.892;对152个结节均予以高频超声诊断,经诊断发现其灵敏度、特异度、准确度分别为95.45%、83.18%、91.15%,AUS为0.877;对152个结节中的94个疑似恶性结节予以US-FNAB诊断,经诊断发现其灵敏度、特异度、准确度分别为9 6.03%、93.65%、95.24%,AUS为0.948。结论 对于内部低回声、结节形态不规则且姐姐内存在钙化,加之边缘不清晰等超声影像学征像患者而言,实施高频超声诊断PTMC应用价值较高,虽然高频超声、US-FNAB在PTMC诊断中均具有较高应用价值,但相对US-FNAB而言,高频超声操作简便、成本较低,且无创伤性,对于不存在高危因素的患者而言,可经由高频超声明确诊断。

高频超声及超声引导下细针穿刺对甲状腺乳头状癌的诊断价值

目的探究高频超声(HFUS)及超声引导下细针穿刺(US-FNAB)在甲状腺乳头状癌(PTC)中的诊断价值。方法回顾性选取河南电力医院2021年1月至2022年1月收治的64例PTC患者(共72个结节)的临床资料,均经病理学、HFUS及US-FNAB检查。以手术病理学结果为金标准,采用受试者工作特征(ROC)曲线分析HFUS、US-FNAB对PTC良恶性的诊断效果。结果72个结节中有47个PTC结节,25个甲状腺良性结节(BTN)结节。其中HFUS检出51个PTC结节,21个BTN结节;US-FNAB检出49个PTC结节,23个BTN结节。PTC和BTN组结节的纵横比、结节形态、结节边缘形态、结节内部回声、回声均匀度和内部钙化征等参数比较,差异具有统计学意义(P<0.05)。HFUS、US-FNAB对PTC诊断灵敏度分别为93.62%(44/47)、95.74%(45/47),特异度分别为72.00%(18/25)、74.00%(21/25),准确性分别为86.11%(62/72)、91.67%(66/72),与病理结果一致性Kappa值分别为0.682、0.813。二者联合检测的诊断效能最高,灵敏度、特异度、准确性、Kappa和AUC分别为89.63%、92.72%、95.83%、0.907、0.949。结论HFUS、US-FNAB均对PTC具有一定诊断价值,不同性质的甲状腺结节的HFUS影像学表现存在较大差异,在HFUS基础上进一步采用US-FNAB检测可以提高对PTC诊断效能。

超声引导下甲状腺FNAB联合BRAF V600E基因检测对甲状腺微小结节的诊断价值

目的:探讨超声引导下甲状腺细针穿刺活检(FNAB)联合丝/苏氨酸特异性激酶基因突变基因V600E(BRAF V600E)检测对甲状腺微小结节的诊断价值。方法:选取2020年10月~2021年10月于我院进行甲状腺切除术患者67例,术前均接受甲状腺FNAB及BRAF V600E基因检测,并与术后病理结果进行比对分析。结果:与术前单一进行FNAB相比,术前FNAB联合BRAF V600E基因检测的术后病理符合率(94.03%),特异度(97.14%),敏感度(90.63%)均高于单一FNAB检查,差异有统计学意义(P<0.05)。结论:超声引导下甲状腺FNAB联合BRAF V600E检测可提高甲状腺微小结节术前检出率,对患者治疗及疾病诊断具有较高的参考价值。

高频超声与超声引导下甲状腺穿刺活检在甲状腺结节术前诊断中的应用价值

目的探究高频超声与超声引导下甲状腺穿刺活检(US-FNAB)在甲状腺结节术前诊断中的应用价值。方法选取2020年5月至2021年10月萍乡市人民医院收治的82例甲状腺结节检查患者作为研究对象,均行高频超声和US-FNAB检查,以病理检查为金标准,分析诊断结果,比较两种检查方式在甲状腺结节术前诊断中的诊断效能及比较高频超声检查良恶性结节形态特征。结果经病理检查检出良性结节66例,恶性结节16例;高频超声检出良性结节61例,恶性结节21例;US-FNAB检出良性结节65例,恶性结节17例。高频超声检查的恶性结节形态不规则、边缘钙化灶、边界模糊、血流Ⅲ型、低回声占比均高于良性结节,差异有统计学意义(P<0.05)。高频超声诊断灵敏度为87.88%、特异度为81.25%、准确率为86.59%、阳性预测值为95.08%、阴性预测值为61.90%,与病理一致性Kappa值为0.618;US-FNAB诊断灵敏度为93.94%、特异度为81.25%、准确率为91.46%、阳性预测值为95.38%、阴性预测值为76.47%,与病理一致性Kappa值为0.735。US-FNAB检查的诊断灵敏度、准确率、阴性预测值均高于高频超声检查,但差异无统计学意义。结论高频超声及US-FNAB诊断甲状腺良恶性结节诊断价值均较高,US-FNAB诊断价值高于高频超声,具有临床实用价值。

超声引导下的甲状腺穿刺活检结合膜式薄层细胞积液细胞学技术检查在甲状腺微小结节术前诊断中的应用价值

目的探讨超声引导下的甲状腺穿刺活检(FNAB)结合膜式薄层积液细胞学技术(TCT)在甲状腺微小结节术前诊断中的应用价值。方法选取2021年3月至2022年6月九江市中医医院收治的75例甲状腺微小结节患者作为研究对象,均接受超声引导下FNAB结合TCT检查,分析手术病理检查结果。以手术病理结果为金标准,分析超声引导下FNAB结合TCT检查的诊断价值及并发症发生情况。结果手术病理检查结果显示,75例患者中,检出直径5~10mm结节40例,直径<5mm结节35例。超声引导下FNAB结合TCT检查诊断直径5~10 mm结节的特异度、灵敏度、准确率分别为80.00%、94.29%、92.50%,诊断直径<5 mm结节的特异度、灵敏度、准确率分别为80.00%、93.33%、91.43%。超声引导下FNAB结合TCT检查后患者并发症发生率为5.33%。结论甲状腺微小结节术前诊断中应用超声引导下FNAB结合TCT检查具有较高的特异度、灵敏度及准确率,且并发症发风险低,值得临床推广应用。

超声引导下细针吸取细胞学检查对甲状腺结节的诊断价值

目的评估超声引导下细针吸取细胞学检查(US-FNA)对甲状腺结节的诊断价值。方法对2004年11月至2008年10月在北京协和医院就诊的168例患者的175个甲状腺结节进行US-FNA检查,将穿刺细胞学诊断资料与手术病理及临床随访结果进行对照分析。细胞学诊断结果分为良性、恶性、可疑恶性及涂片不满意4类。结果175个结节中,经病理及临床随访证实39个为恶性结节,136个为良性结节;经细胞学诊断124个(70.9%)为良性,24个(13.7%)为恶性,14个(8.0%)为可疑恶性,13个(7.4%)为涂片不满意。细胞学诊断敏感性81.1%,特异性93.6%,准确性90.7%,阳性预测值78.9%,阴性预测值94.4%。3例(1.7%)发生穿刺后出血。结论甲状腺US-FNA检查诊断准确性较好,并发症少,有临床实用价值。

应用细针穿刺制作细胞块技术诊断腮腺区肿块的临床意义

目的探讨超声引导下细针穿刺制作细胞块在诊断腮腺区肿块方面的应用价值。方法在彩色超声仪引导下,对285个腮腺区肿块进行细针穿刺,将穿刺标本制成细胞块,以进行病理学诊断。对非肿瘤性肿块采取保守治疗,囊肿与肿瘤性肿块采取手术治疗。对术后病理确诊为腺样囊性癌(ACC)与多形性腺瘤(PA)对应的细胞块行干细胞因子受体CD117免疫组织化学检测。结果标本制作满意率为95.1%(271/285),诊断准确率为94.5%(256/271);诊断敏感度为87.0%(67/77),特异度为98.1%(157/160)。CD117在ACC中的阳性表达率为95.2%(20/21),在PA中为20.3%(25/123),ACC中阳性表达率明显高于PA,二者差异有统计学意义(P<0.01)。结论超声引导下腮腺区肿块细针穿刺制作细胞块结合分子标志物检测,对腮腺区肿块的诊断具有重要意义。

细针穿吸细胞学检查在腮腺区肿块诊断中的价值

目的评价细针穿吸细胞学检查(FNAC)在腮腺区肿块诊断中的应用价值。方法应用细针穿吸方法,对121例腮腺区肿块患者进行细胞学检查,其中男性62例,女性59例;年龄5～95岁,平均年龄57.88岁。将细胞学检查结果与术后组织病理和随访资料进行比较研究。结果FNAC的定性诊断准确率为92.56%(112/121),诊断准确率为89.26%。肿瘤的敏感性为91.25%,特异性为100%;7例患者为假阴性,假阴性率为8.75%;良、恶性病变的敏感性为70.97%,特异性为100%;9例患者为假阴性,假阴性率为29.03%,无假阳性患者。无临床并发症。结论FNAC在腮腺区肿块的诊断中有重要作用,是一种经济、快速、安全、并发症少见和诊断准确率高的细胞学诊断手段。

不同方法经皮穿刺肺活检对肺部肿块的诊断价值

目的比较三种不同方法经皮穿刺肺活检对肺部肿块的诊断价值。方法在X线透视、超声及CT引导下对107例肺部病变患者进行肺活检。结果三种穿刺方法均能获得较高的诊断率,并发症主要是气胸、咯血和血胸,CT引导发生率较高。结论三种穿刺方法均是安全的,临床值得开展。