细针穿刺抽吸针与末端切割型细针穿刺活检针用于超声内镜引导胰腺实性占位诊断的效能比较

Comparison of the diagnostic efficacy between fine needle aspiration needles and end‑cutting fine needle biopsy needles in endoscopic ultrasound‑guided tissue acquisition for solid pancreatic lesions

摘要:

目的 比较22 G细针穿刺抽吸（fine needle aspiration，FNA）针和22 G末端切割型细针穿刺活检（fine needle biopsy，FNB）针在细胞学联合组织学病理检查时对胰腺实性占位病变的诊断效能。方法 回顾性分析2022年6月至2023年3月因胰腺实性占位在上海交通大学医学院附属瑞金医院消化内镜中心接受超声内镜引导细针穿刺抽吸/活检术（endoscopic ultrasound‑guided fine needle aspiration/biopsy，EUS‑FNA/B）的116例患者的临床资料。根据穿刺针类型分为FNA组（63例使用22 G FNA针）和FNB组（53例使用22 G FNB针）。比较两组在胰腺实性占位中鉴别病变良恶性的准确率、敏感度、特异度、阳性预测值、阴性预测值，并分别比较细胞学病理和组织学病理的诊断效能。结果 FNA组和FNB组患者在年龄、性别、病变位置、病变大小、穿刺针数方面差异无统计学意义（P>0.05）。FNA组和FNB组细胞学联合组织学诊断病变良恶性的准确率［93.7%（59/63）比90.6%（48/53），P=0.730］、敏感度［93.0%（53/57）比90.2%（46/51），P=0.732］、特异度［100.0%（6/6）比100.0%（2/2），P=1.000］、阳性预测值［100.0%（53/53）比100.0%（46/46），P=1.000］、阴性预测值［60.0%（6/10）比28.6%（2/7），P=0.335］差异无统计学意义。FNA组细胞学联合组织学诊断病变良恶性的准确率优于单一细胞学诊断［93.7%（59/63）比81.0%（51/63），P=0.008］，具有优于单一组织学诊断的趋势［93.7%（59/63）比87.3%（55/63），P=0.125］；FNB组细胞学联合组织学诊断病变良恶性的准确率优于单一细胞学［90.6%（48/53）比69.8%（37/53），P=0.001］，与单一组织学诊断差异无统计学意义［90.6%（48/53）比90.6%（48/53），P=1.000］。对于胰体尾部占位，FNB组组织学诊断病变良恶性的准确率表现出优于FNA组组织学诊断的趋势［100.0%（17/17）比81.3%（26/32），P=0.080］。结论 联合细胞学与组织学病理诊断，22 G FNA针和22 G FNB针对于鉴别胰腺实性占位病变的良恶性都具有较高的诊断效能，但FNB针获取的组织学诊断效能可能更高。

Abstract:

Objective To compare the diagnostic efficacy of 22 G fine needle aspiration (FNA) needles and 22 G end-cutting fine needle biopsy (FNB) needles for solid pancreatic lesion using both cytological and histological examination. Methods Clinical data of 116 patients who underwent endoscopic ultrasound-guided fine needle aspiration/biopsy (EUS-FNA/FNB) at the Digestive Endoscopy Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from June 2022 to March 2023 were retrospectively analyzed. Sixty-three patients sampled with 22 G FNA needles were the FNA group, and 53 sampled with 22 G FNB needles were the FNB group. The diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and cytological and histological diagnostic yield of FNA needles and FNB needles for solid pancreatic lesions were compared. Results There were no significant differences in age, gender, lesion location, lesion size, or the number of passes between the FNA group and the FNB group (P>0.05). There were no significant differences in the diagnostic accuracy [93.7% (59/63) VS 90.6% (48/53), P=0.730], sensitivity [93.0% (53/57) VS 90.2% (46/51), P=0.732], specificity [100.0% (6/6) VS 100.0% (2/2), P=1.000], positive predictive value [100.0% (53/53) VS 100.0% (46/46), P=1.000] and negative predictive value [60.0% (6/10) VS 28.6% (2/7), P=0.335] of combined cytology and histology in distinguishing benign and malignant lesions between the two groups. In the FNA group, the diagnostic accuracy of combined cytology and histology was higher than cytology alone [93.7% (59/63) VS 81.0% (51/63), P=0.008], and was higher than histology alone without statistical significance [93.7% (59/63) VS 87.3% (55/63), P=0.125]. In the FNB group, the diagnostic accuracy of combined cytology and histology was higher than cytology alone [90.6% (48/53) VS 69.8% (37/53), P=0.001], but not than histology alone [90.6% (48/53) VS 90.6% (48/53)，P=1.000]. For solid masses located in pancreatic body/tail, the diagnostic accuracy for malignancy by histology using FNB needles tended to be higher than that of FNA needles [100.0% (17/17) VS 81.3% (26/32), P=0.080]. Conclusion Both FNA needles and FNB needles exhibit adequate diagnostic yield for solid pancreatic masses when combining cytology and histology. FNB needles may offer a higher histological diagnostic yield.