Endoscopic ultrasound(EUS)is an imaging technique that has consolidated its role as an important tool for diagnosis and therapeutics.In recent years we have seen a dramatic increase in the number of EUS-guided therape...Endoscopic ultrasound(EUS)is an imaging technique that has consolidated its role as an important tool for diagnosis and therapeutics.In recent years we have seen a dramatic increase in the number of EUS-guided therapeutic indications(celiac plexus neurolysis/block, pseudocyst drainage,etc).Preliminary reports have suggested EUS may also be used to guide vascular access for both imaging and treating different vascular diseases.This review aims to objectively describe the existing evidence in the field.展开更多
目的前瞻性地评价超声内镜引导下细针抽吸活检(endoscopic ultrasound-guided fine needleaspiration,EUS-FNA)在胰腺疾病诊断中的价值及影响其诊断能力的潜在因素分析。方法 2010年9月至2011年8月间就诊于复旦大学附属中山医院内镜中心...目的前瞻性地评价超声内镜引导下细针抽吸活检(endoscopic ultrasound-guided fine needleaspiration,EUS-FNA)在胰腺疾病诊断中的价值及影响其诊断能力的潜在因素分析。方法 2010年9月至2011年8月间就诊于复旦大学附属中山医院内镜中心,经影像学诊断(CT或MRI)为胰腺病变、拟行EUS-FNA的44例患者连续性地纳入本研究。详细记录患者的年龄、性别、病变位置、病变大小、穿刺次数,评价是否获取足够样本供细胞学或组织病理学诊断及穿刺相关并发症等。结果 44例患者中,42例成功实行EUS-FNA(95.5%,42/44),病灶的平均最大直径为(44.7±18.2)mm。31例获得肉眼可见的组织条;意向性分析结果显示,34例穿刺样本(77.3%,34/44)足够用于细胞或组织病理学诊断,包括31例患者获得明确的细胞或组织病理学恶性肿瘤依据,3例诊断为胰腺炎症。病灶的位置、大小与穿刺成功率、明确病理学诊断的获得率无明显关系;而穿刺过程中获得肉眼可见组织样本病例的明确病理学诊断获得率明显高于未获得者(P=0.000)。2例患者于穿刺时发生穿刺点渗血(4.8%,2/42),通过电凝及止血夹处理好转。结论在胰腺疾病的诊断中,EUS-FNA具有良好的安全性和有效性。如何在安全的前提下获取更多的组织量用于病理学评估是提高EUS-FNA诊断能力的关键。展开更多
Pancreatic cystic and neoplasms are being diagnosed with increasing frequency. Accurate diagnosis and determination of benign versus malignant lesions is crucial for determining need for surveillance versus surgery or...Pancreatic cystic and neoplasms are being diagnosed with increasing frequency. Accurate diagnosis and determination of benign versus malignant lesions is crucial for determining need for surveillance versus surgery or endoscopic therapy as well as avoiding unnecessary surgery in cysts with no malignant potential. Tumor markers such as KRAS and GNAS hold promise, but which molecular marker or a combination of markers is most useful and cost effective remains to be seen. Advanced imaging with confocal laser endomicroscopy can serve as an optical biopsy and play a part in the diagnostic algorithm. Microforceps aided biopsy of pancreatic cyst wall and tumor contents hold great promise as they allow direct tissue acquisition. Much progress has been made in the role of EUS guided evaluation of pancreatic cystic neoplasms over the last several years, and with the advances enumerated above, the future is more than just a few shades of grey. Future studies should include prospective multiarm trials of microforceps biopsy versus conventional EUS-FNA and use of biochemical and molecular markers, confocal laser endomicroscopy or a combination thereof to determine best approach to pancreatic cystic neoplasms. In Osler's words, ‘Medicine is a science of uncertainty and an art of probability'. Incorporation of advanced imaging and molecular markers into a new diagnostic algorithm with subsequent validation through retrospective and prospective studies has the potential to increase diagnostic accuracy and guide optimal management of patients and improve outcomes.展开更多
Background: Endoscopic ultrasonography (EUS) is well-established, highly accurate clinical diagnostic test for detection and staging of gastrointestinal tract lesions and related organs. The addition of endoscopic gui...Background: Endoscopic ultrasonography (EUS) is well-established, highly accurate clinical diagnostic test for detection and staging of gastrointestinal tract lesions and related organs. The addition of endoscopic guided fine needle aspiration cytology (EUS-FNAC) has improved the performance characteristics of EUS. Aim: Evaluate the validity of EUS-FNAC in diagnosis of gastrointestinal tract lesions and related organs and assess predictive factors for an accurate EUS-FNAC diagnosis. Methods: Our study included cytological sampling from one hundred sixty-six lesions obtained from gastrointestinal tract and related organs. Factors affecting EUS-FNA accuracy were analyzed. The histopathological results or clinical follow-up were used as the gold standard method. Results: Samples were obtained from: pancreatic masses (n = 80), gastric masses (n = 34), lymph nodes (n = 22), hepatobiliary masses (n = 18) and rectal masses (n = 2). Statistical analysis of sensitivity, specificity, Positive Predictive Value, Negative Predictive Value, and diagnostic accuracy of EUS alone was 80.4%, 51.6%, 75.8%, 76.2% and 75.9% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNAC are 78.8%, 96.8%, 97.6% and 73.2% respectively. Addition of FNAC to EUS improved diagnostic accuracy to 85.5%. Positive statistical association was present between cytological adequacy and adequate cell block preparations, larger lesion size, presence of rapid on site evaluation (ROSE) and obtaining at least two passes from target lesion. Conclusions: EUS is valuable diagnostic and cost effective tool for gastrointestinal tract lesions and related organs when combined with FNAC.展开更多
文摘Endoscopic ultrasound(EUS)is an imaging technique that has consolidated its role as an important tool for diagnosis and therapeutics.In recent years we have seen a dramatic increase in the number of EUS-guided therapeutic indications(celiac plexus neurolysis/block, pseudocyst drainage,etc).Preliminary reports have suggested EUS may also be used to guide vascular access for both imaging and treating different vascular diseases.This review aims to objectively describe the existing evidence in the field.
文摘Pancreatic cystic and neoplasms are being diagnosed with increasing frequency. Accurate diagnosis and determination of benign versus malignant lesions is crucial for determining need for surveillance versus surgery or endoscopic therapy as well as avoiding unnecessary surgery in cysts with no malignant potential. Tumor markers such as KRAS and GNAS hold promise, but which molecular marker or a combination of markers is most useful and cost effective remains to be seen. Advanced imaging with confocal laser endomicroscopy can serve as an optical biopsy and play a part in the diagnostic algorithm. Microforceps aided biopsy of pancreatic cyst wall and tumor contents hold great promise as they allow direct tissue acquisition. Much progress has been made in the role of EUS guided evaluation of pancreatic cystic neoplasms over the last several years, and with the advances enumerated above, the future is more than just a few shades of grey. Future studies should include prospective multiarm trials of microforceps biopsy versus conventional EUS-FNA and use of biochemical and molecular markers, confocal laser endomicroscopy or a combination thereof to determine best approach to pancreatic cystic neoplasms. In Osler's words, ‘Medicine is a science of uncertainty and an art of probability'. Incorporation of advanced imaging and molecular markers into a new diagnostic algorithm with subsequent validation through retrospective and prospective studies has the potential to increase diagnostic accuracy and guide optimal management of patients and improve outcomes.
文摘Background: Endoscopic ultrasonography (EUS) is well-established, highly accurate clinical diagnostic test for detection and staging of gastrointestinal tract lesions and related organs. The addition of endoscopic guided fine needle aspiration cytology (EUS-FNAC) has improved the performance characteristics of EUS. Aim: Evaluate the validity of EUS-FNAC in diagnosis of gastrointestinal tract lesions and related organs and assess predictive factors for an accurate EUS-FNAC diagnosis. Methods: Our study included cytological sampling from one hundred sixty-six lesions obtained from gastrointestinal tract and related organs. Factors affecting EUS-FNA accuracy were analyzed. The histopathological results or clinical follow-up were used as the gold standard method. Results: Samples were obtained from: pancreatic masses (n = 80), gastric masses (n = 34), lymph nodes (n = 22), hepatobiliary masses (n = 18) and rectal masses (n = 2). Statistical analysis of sensitivity, specificity, Positive Predictive Value, Negative Predictive Value, and diagnostic accuracy of EUS alone was 80.4%, 51.6%, 75.8%, 76.2% and 75.9% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNAC are 78.8%, 96.8%, 97.6% and 73.2% respectively. Addition of FNAC to EUS improved diagnostic accuracy to 85.5%. Positive statistical association was present between cytological adequacy and adequate cell block preparations, larger lesion size, presence of rapid on site evaluation (ROSE) and obtaining at least two passes from target lesion. Conclusions: EUS is valuable diagnostic and cost effective tool for gastrointestinal tract lesions and related organs when combined with FNAC.
