■EUS引导的细针活检(EUS-FNB)优于细针穿刺活检(FNA)仍存在争议。本研究旨在比较FNB和FNA在免疫组织化学(IHC)所需病变中的疗效,包括,1型自身免疫性胰腺炎(AIP),神经内分泌肿瘤(NET),间充质肿瘤,和淋巴瘤。
■在这项多中心研究中,我们对所有接受EUS-FNB/FNA治疗的患者标本进行前瞻性评估.人口统计,IHC标本的充分性,诊断准确性,并对组织的完整性进行了分析。还进行了亚组分析和多变量逻辑回归以控制混杂因素。
■共纳入439例患者进行分析。大多数病变类型为1型AIP(41.69%),其次是NET,间充质肿瘤,和淋巴瘤。FNB产生的标本对IHC具有更好的充分性(82.41%vs.66.67%,P<0.001)和更高的诊断准确性(74.37%vs.55.42%,P<0.001)。FNB在IHC充分性方面优于FNA(赔率比,2.786[1.515-5.291])和诊断准确性(赔率比,2.793[1.645-4.808])在控制包括针头大小在内的混杂因素后仍然显著,病变部位,病变大小,和内窥镜师。在亚组分析中,FNB在AIP和间充质肿瘤中显示出更高的诊断准确性,而在NET和淋巴瘤中没有观察到统计学上的显著差异。
■FNB在获得具有更好充分性和完整性的组织方面优于FNA针。这些结果表明,FNB应被认为是诊断需要IHC的病变的一线模式。尤其是AIP和间充质肿瘤。然而,我们需要一个更大样本量的随机对照试验来进一步证实我们的发现.
UNASSIGNED: The superiority of EUS-guided fine-needle biopsy (EUS-FNB) over fine-needle aspiration (FNA) remains controversial. This
study aimed to compare the efficacy of FNB and FNA in immunohistochemistry (IHC)-required lesions, including, type 1 autoimmune pancreatitis (AIP), neuroendocrine tumor (NET), mesenchymal tumor, and lymphoma.
UNASSIGNED: In this multicenter
study, specimens from all eligible patients who underwent EUS-FNB/FNA with these specific lesions were prospectively evaluated. Demographics, adequacy of specimens for IHC, diagnostic accuracy, and integrity of tissue were analyzed. Subgroup analysis and multivariate logistic regression were also performed to control confounders.
UNASSIGNED: A total of 439 patients were included for analysis. Most lesion types were type 1 AIP (41.69%), followed by NET, mesenchymal tumor, and lymphoma. FNB yielded specimens with better adequacy for IHC (82.41% vs. 66.67%, P < 0.001) and higher diagnostic accuracy (74.37% vs. 55.42%, P < 0.001). The superiority of FNB over FNA in adequacy for IHC (odds ratio, 2.786 [1.515-5.291]) and diagnostic accuracy (odds ratio, 2.793 [1.645-4.808]) remained significant after control of confounders including needle size, lesion site, lesion size, and endoscopists. In subgroup analysis, FNB showed higher diagnostic accuracy in AIP and mesenchymal tumor, whereas no statistically significant difference was observed in NET and lymphoma.
UNASSIGNED: FNB was superior to FNA needles in obtaining tissues with better adequacy and integrity. These results suggest that FNB should be considered a first-line modality in the diagnosis of IHC-required lesions, especially AIP and mesenchymal tumor. However, a randomized controlled
trial with larger sample size is needed to further confirm our findings.