PDF(Pubmed)
Abstract：
Evidence comparing ultrasound endoscopy-guided fine-needle biopsy (EUS-FNB) with EUS-guided fine-needle aspiration (EUS-FNA) in deep-seated lymphoma tissue sampling is insufficient. This study aims to evaluate the diagnostic efficacy of immunohistochemistry (IHC) or flow cytometry (FCM) on specimens obtained from EUS-FNB and EUS-FNA in the diagnosis and staging of deep-seated lymphomas. This real-world, dual-center study prospectively evaluated all eligible specimens from patients who underwent EUS-FNB/FNA over an 8-year period. 53 patients were enrolled, with 23 patients in the EUS-FNB group and 30 patients in the EUS-FNA group. FNB yielded specimens with longer core tissues (0.80 mm [0.55, 1.00] vs. 0.45 mm [0.30, 0.50], p = 0.009) and higher scores of specimen adequacy [4 (3.75, 4.00) vs. 3 (1.00, 4.00), p = 0.025]. Overall analysis revealed that the diagnostic accuracy of IHC based on specimens acquired from EUS-FNB was significantly higher than that of EUS-FNA (91.30% vs. 60.00%, p = 0.013). After controlling confounding factors including lesion size and endoscopists, EUS-FNB with IHC maintained a higher-level diagnostic accuracy compared to EUS-FNA (OR = 1.292 [1.037-1.609], p = 0.023). When FCM was additionally used to analyze the specimen acquired from EUS-FNA, the diagnostic yield was significantly improved (ROC AUC: 0.733 vs. 0.550, p = 0.015), and the AUC of FNB alone or combined with FCM was 0.739 and 0.761. Conclusions: FNB needles generate higher histopathological diagnostic accuracy and specimen quality than FNA for the deep-seated lymphoma. Though the application of FCM significantly improves the diagnostic efficacy of EUS-FNA, FNB was still the preferred diagnostic modality with a shorter procedure time, comparable diagnostic accuracy, and better cost-effectiveness.
摘要：
在深层淋巴瘤组织采样中，超声内镜引导的细针活检（EUS-FNB）与EUS引导的细针穿刺（EUS-FNA）的比较证据不足。本研究旨在评估免疫组织化学（IHC）或流式细胞术（FCM）对从EUS-FNB和EUS-FNA获得的标本在深部淋巴瘤的诊断和分期中的诊断功效。这个现实世界,双中心研究前瞻性评估了在8年内接受EUS-FNB/FNA治疗的患者的所有合格标本.纳入53例患者，EUS-FNB组23例，EUS-FNA组30例。FNB产生的标本具有更长的核心组织（0.80mm[0.55，1.00]与0.45mm[0.30,0.50],p=0.009）和更高的样本充分性得分[4（3.75，4.00）与3(1.00,4.00),p=0.025]。总体分析显示，基于EUS-FNB采集标本的IHC诊断准确率明显高于EUS-FNA（91.30%vs.60.00%,p=0.013)。在控制包括病变大小和内镜医师在内的混杂因素后，与EUS-FNA相比，具有IHC的EUS-FNB保持了更高水平的诊断准确性（OR=1.292[1.037-1.609]，p=0.023)。当额外使用FCM分析从EUS-FNA获得的样本时，诊断率显著提高(ROCAUC：0.733vs.0.550，p=0.015)，FNB单独或联合FCM的AUC分别为0.739和0.761。结论：FNB针比FNA对深部淋巴瘤具有更高的组织病理学诊断准确性和标本质量。尽管FCM的应用显著提高了EUS-FNA的诊断效能,FNB仍然是首选的诊断方式，手术时间较短。相当的诊断准确性，和更好的成本效益。
