目的:随着新活检装置的出现,可以从胰腺肿块中获得细针穿刺活检标本。本研究旨在报道细针穿刺活检胰腺内腺癌的组织学谱和采样的准确性。
结果:我们确定了423例SharkCore™细针穿刺活检,这些活检取自临床高度关注胰腺腺癌的患者。对于每一个,我们记录了病人的年龄和性别,每个样本和肿瘤部位的诊断组织百分比,大小和组织学发现。病例来自392名患者(193名男性,199名妇女;平均年龄69岁)。样品中的平均诊断组织量为30%。常见的组织学检查结果包括结缔组织增生(36%),单个非典型细胞(44%),杂乱无章的腺体生长模式(68%),核多态性>4:1(39%),不完整的腺腔(18%)和脱离的非典型上皮条(37%)。对143例案件下令增加水平。与423例相关的最终临床诊断为腺癌(n=343),胰腺炎(n=22),导管内肿瘤或其他良性/低度病变(n=16)和未知(n=42,患者失访)。在腺癌病例中,仅通过评估的细针芯式活检样本,在178例病例中,仅通过细针抽吸活检,在30例病例中,同时在89例病例中,以及在37例病例中,通过随后的活检或切除确定了诊断.在细针穿刺活检可疑的68例病例中,78%最终代表腺癌。
结论:细针穿刺活检可用于胰腺腺癌的组织学诊断,使用已知的组织学参数。常见的发现包括单个非典型细胞,结缔组织增生,杂乱无章的腺体生长和核多态性。被解释为可疑的病例通常代表恶性肿瘤。
OBJECTIVE: With the advent of new biopsy devices, fine-needle core biopsy specimens can be obtained from pancreas masses. This study aimed to report the histological spectrum of intrapancreatic adenocarcinoma on fine-needle core biopsy and the accuracy of sampling.
RESULTS: We identified 423 SharkCore™ fine-needle core biopsies taken from patients with a high clinical concern for pancreatic adenocarcinoma. For each, we recorded patient age and sex, percentage of diagnostic tissue in each sample and tumour site, size and histological findings. The cases came from 392 patients (193 men, 199 women; mean age 69 years). Median diagnostic tissue amount in the samples was 30%. Common histological findings included desmoplasia (36%), single atypical cells (44%), haphazard glandular growth pattern (68%), nuclear pleomorphism > 4:1 (39%), incomplete gland lumens (18%) and detached atypical epithelial strips (37%). Additional levels were ordered on 143 cases. Final clinical diagnoses associated with the 423 cases were adenocarcinoma (n = 343), pancreatitis (n = 22), intraductal neoplasm or other benign/low-grade process (n = 16) and unknown (n = 42, patients lost to follow-up). Of the adenocarcinoma cases, the diagnosis was established by the evaluated fine-needle core biopsy sample alone in 178, by fine-needle aspiration biopsy alone in 30, by both concurrently in 89 and by subsequent biopsy or resection in 37 cases. Among 68 cases called suspicious on fine-needle core biopsy, 78% ultimately represented adenocarcinoma.
CONCLUSIONS: Fine-needle core biopsy allows for histological diagnosis of pancreatic adenocarcinoma, using known histological parameters. Common findings include single atypical cells, desmoplasia, haphazard gland growth and nuclear pleomorphism. Cases interpreted as suspicious often represent malignancy.