关键词: ductal pancreatic adenocarcinoma endoscopic ultrasound (eus) fine needle aspiration biopsy (fnac) histology pancreatic neoplasms tissue acquisition

来  源:   DOI:10.7759/cureus.41576   PDF(Pubmed)

Abstract:
OBJECTIVE: Compare the 22G needle versus EchoTip ProCore® 20 (Cook Medical, Bloomington, IN, USA) on their handling, specimen suitability, amount of tissue obtained, diagnostic performance, the possibility of immunohistochemistry, and rate of adverse events.
METHODS: This is a retrospective, comparative study of consecutively examined patients with pancreatic masses who underwent endosonography-guided fine needle aspiration (FNA) via the 22G needle, and endosonography-guided tissue acquisition (TA) via ProCore 20 (PC20). The operator evaluated needle insertion and subjectively classified the specimen. The pathologist measured the samples, classified the amount of tissue, and determined the influence of bleeding on the interpretation.
RESULTS: A total of 129 patients participated in the study, out of whom 52 underwent endosonography-guided FNA with 22G and 77 underwent endosonography-guided TA with a PC20 needle. Malignant lesions were found in 106, and 23 had benign lesions. The duodenal route was used in 62% of patients. The 22G needle was easier to introduce (p=0.0495). However, PC20 obtained a larger amount (p<0.01) with fewer punctures (p<0.001). The PC20 also yielded a larger average microcore diameter (p=0.0032). Microhistology was adequate for 22G and PC20 in 22 (42.2%) and 50 (78.1%) specimens, respectively (p<0.001). Bleeding was not significantly different (p>0.999). Immunohistochemistry was possible in 36 (69.2%) and 40 (51.9%) specimens obtained by 22G and PC20, respectively (p=0.075). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 22G were 93.5%, 100%, 100%, 66.7%, and 94.2%, respectively; and for PC20, it was 95%, 100%, 100%, 85%, and 96.1%, respectively. Mild bleeding was the most common early adverse event, occurring in 2/52 (3.8%) 22G and 4/77 (5.2%) PC20 cases (p>0.05).
CONCLUSIONS: The PC20 required fewer punctures and reduced the need for immunohistochemistry as it yielded better and larger microcores. Its ease of insertion into the target lesion makes it a good option to obtain satisfactory microcore specimens in difficult positions, such as the transduodenal route.
摘要:
目标:比较22G针头与EchoTipProCore®20(CookMedical,布卢明顿,IN,美国)关于他们的处理,标本适用性,获得的组织数量,诊断性能,免疫组织化学的可能性,和不良事件发生率。
方法:这是一个回顾性研究,连续检查的胰腺肿块患者的比较研究,这些患者接受了通过22G针行内镜引导的细针穿刺(FNA),和通过ProCore20(PC20)的内窥镜引导的组织采集(TA)。操作者评估针插入并主观地对样本进行分类。病理学家测量了样本,对组织的数量进行分类,并确定出血对解释的影响。
结果:共有129名患者参与了这项研究,其中52例接受了22G内窥镜引导的FNA,77例接受了PC20针头内窥镜引导的TA。106例恶性病变,23例良性病变。62%的患者使用十二指肠途径。22G针更容易引入(p=0.0495)。然而,PC20以更少的穿刺(p<0.001)获得更大的量(p<0.01)。PC20还产生较大的平均微芯直径(p=0.0032)。22例(42.2%)和50例(78.1%)标本中22G和PC20的显微组织学检查是足够的,分别(p<0.001)。出血没有显著差异(p>0.999)。分别在22G和PC20获得的36例(69.2%)和40例(51.9%)标本中进行了免疫组织化学(p=0.075)。敏感性,特异性,正预测值,负预测值,22G的准确度为93.5%,100%,100%,66.7%,94.2%,分别是;对于PC20,它是95%,100%,100%,85%,96.1%,分别。轻度出血是最常见的早期不良事件,2/52(3.8%)22G和4/77(5.2%)PC20例(p>0.05)。
结论:PC20需要更少的穿刺,并减少了对免疫组织化学的需要,因为它产生了更好和更大的微核。它易于插入目标病变,使其成为在困难位置获得满意的微芯标本的好选择,如经十二指肠途径。
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