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
目的:探讨超声引导下细针抽吸活检(ultrasound-guided fine needle aspiration biospy,US-FNAB)对甲状腺恶性病变中亚型的诊断准确率。方法:回顾性分析2010年1月至2019年12月间9933例在上海交通大学医学院附属瑞金医院接受US-FNAB者的...目的:探讨超声引导下细针抽吸活检(ultrasound-guided fine needle aspiration biospy,US-FNAB)对甲状腺恶性病变中亚型的诊断准确率。方法:回顾性分析2010年1月至2019年12月间9933例在上海交通大学医学院附属瑞金医院接受US-FNAB者的相关资料,共10388个甲状腺结节,以术后病理为金标准,评价US-FNAB诊断甲状腺癌的灵敏度、特异度、准确率、阳性预测值、阴性预测值等,并进一步分析其在恶性病变中各亚型的诊断准确率。结果:总结10年间的US-FNAB结果数据发现,10388个结节中有9379个(90.3%)为恶性,总诊断灵敏度为95.4%,总特异度为84.7%,总阳性预测值98.4%,总阴性预测值为65.9%,总诊断准确率达94.4%;对于各恶性病变亚型,乳头状癌的诊断准确率为95.8%,髓样癌的诊断准确率为69.4%。结论:US-FNAB在恶性甲状腺结节诊断中具有较高的价值,其对甲状腺乳头状癌的诊断效能最高。展开更多
Background: Endoscopic ultrasonography-guided fine-nee-dle aspiration biopsy (EUS-FNAB) has come into widespread use, mainly in Western countries, as an efficient and safe method for the cytologic or histologic diagno...Background: Endoscopic ultrasonography-guided fine-nee-dle aspiration biopsy (EUS-FNAB) has come into widespread use, mainly in Western countries, as an efficient and safe method for the cytologic or histologic diagnosis of pancreatic cancer. However, it still has received relatively little attention in Japan. To evaluate the clinical status of EUS-FNAB in Japan, we retrospectively analyzed the results with regard to the ability of EUS-FNAB to diagnose pancreatic cancer, as well as its safety. Methods: A total of 52 patients (37 male, 15 female; mean age, 62.5 years; range, 33-85 years) with focal pancreatic lesions underwent EUS-FNAB at our group of hospitals in one region of Japan. Final diagnosis was confirmed by histologic examination of surgical specimens or clinical follow-up. Results: The final diagnoses were malignant tumors in 32 patients and benign ones in 20. Insertion of the needle into the lesion was successful in 50 of the 52 patients (96.2%). Adequate specimens were obtained by EUS-FNAB from 47 of the 50 pancreatic lesions (94.0%). With five false-negative and no false-positive results, the accuracy, sensitivity, specificity, and positive and negative predictive values were 89.4%, 82.1%, 100%, 100%, and 79.2%, respectively. No complications occurred. Conclusions: EUS-FNAB is an efficient and safe method for the histologic diagnosis of pancreatic cancer. It should be considered as one of the indispensable modalities for the histological diagnosis of pancreatic cancer in Japan, as it is in Western countries.展开更多
Background. For the diagnosis of gastric submucosal tumors (SMTs), endoscopic ultrasound (EUS) alone does not reveal the complete pathology, such as the degre e of malignancy, and EUS-guided fine-needle aspiration bio...Background. For the diagnosis of gastric submucosal tumors (SMTs), endoscopic ultrasound (EUS) alone does not reveal the complete pathology, such as the degre e of malignancy, and EUS-guided fine-needle aspiration biopsy (EUS-FNAB) has been reported to be more useful. Recently, most cases initially diagnosed as lei omyosarcomas have received further study with immunohistochemical staining and h ave been given the new diagnosis of gastrointestinal stromal tumors (GISTs). The degree of malignancy of GISTs differs widely in clinical aspects. In this study , we examined whether EUS-FNAB was useful in diagnosing GISTs and differentiati ng their degrees of malignancy. Methods. From January 1997 to March 2002,21 case s of gastric GISTs were diagnosed from the immunohistochemical staining of speci mens resected at Aichi Cancer Center Hospital. Of these 21 patients, 14 (5 with high-grade malignancy and 9 with lowgrade malignancy) underwent EUS-FNAB preop eratively, and were examined further: their EUS-FNAB specimens were submitted f or additional immunohistochemical testing. Results. The EUS-FNAB specimens from all patients were positive for c-kit and CD34 immunohistochemical testing, coi nciding with the staining results of the resected specimens. The MIB-1 labeling indic es in specimens of high-grade malignancy were significantly higher than those o f low-grade malignancy. If we assumed that a tumor with an MIB-1 labeling inde x of more than 5%was a high-grade malignancy, the diagnostic, accuracy was 85. 7%. Conclusions. The EUS-FNAB procedure is a useful tool for diagnosing GISTs of the stomach with immunohistochemical staining. When used with MIB-1 staining , the proceduremay indicateGIST prognosis and influence decisions regarding ther apeutic strategies.展开更多
文摘目的:探讨超声引导下细针抽吸活检(ultrasound-guided fine needle aspiration biospy,US-FNAB)对甲状腺恶性病变中亚型的诊断准确率。方法:回顾性分析2010年1月至2019年12月间9933例在上海交通大学医学院附属瑞金医院接受US-FNAB者的相关资料,共10388个甲状腺结节,以术后病理为金标准,评价US-FNAB诊断甲状腺癌的灵敏度、特异度、准确率、阳性预测值、阴性预测值等,并进一步分析其在恶性病变中各亚型的诊断准确率。结果:总结10年间的US-FNAB结果数据发现,10388个结节中有9379个(90.3%)为恶性,总诊断灵敏度为95.4%,总特异度为84.7%,总阳性预测值98.4%,总阴性预测值为65.9%,总诊断准确率达94.4%;对于各恶性病变亚型,乳头状癌的诊断准确率为95.8%,髓样癌的诊断准确率为69.4%。结论:US-FNAB在恶性甲状腺结节诊断中具有较高的价值,其对甲状腺乳头状癌的诊断效能最高。
文摘Background: Endoscopic ultrasonography-guided fine-nee-dle aspiration biopsy (EUS-FNAB) has come into widespread use, mainly in Western countries, as an efficient and safe method for the cytologic or histologic diagnosis of pancreatic cancer. However, it still has received relatively little attention in Japan. To evaluate the clinical status of EUS-FNAB in Japan, we retrospectively analyzed the results with regard to the ability of EUS-FNAB to diagnose pancreatic cancer, as well as its safety. Methods: A total of 52 patients (37 male, 15 female; mean age, 62.5 years; range, 33-85 years) with focal pancreatic lesions underwent EUS-FNAB at our group of hospitals in one region of Japan. Final diagnosis was confirmed by histologic examination of surgical specimens or clinical follow-up. Results: The final diagnoses were malignant tumors in 32 patients and benign ones in 20. Insertion of the needle into the lesion was successful in 50 of the 52 patients (96.2%). Adequate specimens were obtained by EUS-FNAB from 47 of the 50 pancreatic lesions (94.0%). With five false-negative and no false-positive results, the accuracy, sensitivity, specificity, and positive and negative predictive values were 89.4%, 82.1%, 100%, 100%, and 79.2%, respectively. No complications occurred. Conclusions: EUS-FNAB is an efficient and safe method for the histologic diagnosis of pancreatic cancer. It should be considered as one of the indispensable modalities for the histological diagnosis of pancreatic cancer in Japan, as it is in Western countries.
文摘Background. For the diagnosis of gastric submucosal tumors (SMTs), endoscopic ultrasound (EUS) alone does not reveal the complete pathology, such as the degre e of malignancy, and EUS-guided fine-needle aspiration biopsy (EUS-FNAB) has been reported to be more useful. Recently, most cases initially diagnosed as lei omyosarcomas have received further study with immunohistochemical staining and h ave been given the new diagnosis of gastrointestinal stromal tumors (GISTs). The degree of malignancy of GISTs differs widely in clinical aspects. In this study , we examined whether EUS-FNAB was useful in diagnosing GISTs and differentiati ng their degrees of malignancy. Methods. From January 1997 to March 2002,21 case s of gastric GISTs were diagnosed from the immunohistochemical staining of speci mens resected at Aichi Cancer Center Hospital. Of these 21 patients, 14 (5 with high-grade malignancy and 9 with lowgrade malignancy) underwent EUS-FNAB preop eratively, and were examined further: their EUS-FNAB specimens were submitted f or additional immunohistochemical testing. Results. The EUS-FNAB specimens from all patients were positive for c-kit and CD34 immunohistochemical testing, coi nciding with the staining results of the resected specimens. The MIB-1 labeling indic es in specimens of high-grade malignancy were significantly higher than those o f low-grade malignancy. If we assumed that a tumor with an MIB-1 labeling inde x of more than 5%was a high-grade malignancy, the diagnostic, accuracy was 85. 7%. Conclusions. The EUS-FNAB procedure is a useful tool for diagnosing GISTs of the stomach with immunohistochemical staining. When used with MIB-1 staining , the proceduremay indicateGIST prognosis and influence decisions regarding ther apeutic strategies.
