背景:内镜超声(EUS)引导的组织采集是诊断胰腺病变以及纵隔和腹部淋巴结的首选方式。快速的现场细胞学评估可改善EUS引导的细针穿刺(FNA)的诊断结果,但在许多中心均不可用。或者,宏观现场评估(MOSE)可以改善EUS-FNA的诊断结果,但数据有限。因此,本研究旨在评估MOSE在改善充分性和准确性方面的功效.
方法:我们回顾性分析了2020年12月至2022年12月在三级护理中心接受EUS引导FNA的连续胰腺或淋巴结病变患者的数据。研究的主要结果是EUS引导的组织采集的充分性和诊断准确性,对充分性和准确性的预测因素进行二次分析。
结果:数据来自124例患者(44.4%为男性,中位年龄:54岁)接受EUS-FNA的患者被纳入本分析。据报道,在93/124例(75%)病例中,MOSE上存在宏观可见核心(MVC)。在110/124例(88.7%)病例中获得了足够的组织病理学或细胞学检查样本,而诊断准确率为85.5%。在多变量分析中,发现MOSE无MVC是充分性(OR0.092,95%CI:0.024-0.349)和准确性(OR0.175,95%CI:0.057-0.536)的独立负预测因子.
结论:MOSE上MVC的存在可以作为标本充分性的指标,并可以提高EUS-FNA的诊断率。
BACKGROUND: Endoscopic ultrasound (EUS)-guided tissue acquisition is the preferred modality for diagnosing pancreatic lesions and mediastinal and abdominal lymph nodes. Rapid on-site cytologic evaluation improves the diagnostic outcome of EUS-guided fine-needle aspiration (FNA) but is unavailable at many centers. Alternatively, macroscopic on-site evaluation (MOSE) may improve the diagnostic outcome of EUS-FNA, but data are limited. Hence, the present study was conducted to assess the efficacy of MOSE in improving adequacy and accuracy.
METHODS: We retrospectively analyzed data of consecutive patients with pancreatic or lymph nodal lesions undergoing EUS-guided FNA at a tertiary care center from December 2020 to December 2022. The study\'s primary outcomes were adequacy and diagnostic accuracy of the EUS-guided tissue acquisition, with secondary analysis of predictors of adequacy and accuracy.
RESULTS: Data from 124 patients (44.4% male, median age: 54 years) who underwent EUS-FNA were included in the present analysis. The presence of macroscopic visible core (MVC) on MOSE was reported in 93/124 (75%) cases. An adequate sample for histopathological or cytological examination was obtained in 110/124 (88.7%) cases, while the diagnostic accuracy was 85.5%. On multivariate analysis, the absence of MVC on MOSE was found to be the independent negative predictor of both adequacy (OR 0.092, 95% CI: 0.024-0.349) and accuracy (OR 0.175, 95% CI: 0.057-0.536).
CONCLUSIONS: The presence of MVC on MOSE can be an indicator of specimen adequacy and can improve the diagnostic yield of EUS-FNA.