重复超声内镜引导细针穿刺抽吸术的临床价值

Clinical value of repeated endoscopic ultrasound⁃guided fine⁃needle aspiration

摘要:

目的 探讨重复超声内镜引导细针穿刺抽吸术（endoscopic ultrasound⁃guided fine needle aspiration，EUS⁃FNA）在疑诊肿瘤性病变患者中的诊断价值。方法 收集山东大学齐鲁医院消化内镜中心2018年1月至2023年10月期间因临床疑诊肿瘤性病变行首次EUS⁃FNA不能获得明确的疾病诊断而行重复EUS⁃FNA的所有病例，回顾超声内镜图像、病理、随访转归等病例资料，分析经重复EUS⁃FNA得到明确诊断的患者，评估重复EUS⁃FNA对肿瘤性病变的诊断敏感度、特异度、阳性预测值、阴性预测值及准确率。结果 共有36例不同部位占位性病变患者纳入研究，最终80.6%（29/36）诊断为肿瘤性病变，19.4%（7/36）为非肿瘤性病变，其中34例患者得到明确病种诊断。重复EUS⁃FNA诊断肿瘤性病变灵敏度为82.8%（24/29），特异度为100.0%（7/7），阳性预测值为100.0%（24/24），阴性预测值为58.3%（7/12），准确率为86.1%（31/36）。结论 临床疑诊肿瘤性病变而首次EUS⁃FNA病理结果不明确时，重复EUS⁃FNA是有效可行的方法。

Abstract:

Objective To investigate the diagnostic value of repeated endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in patients with suspected neoplastic lesions. Methods Patients with clinically suspected neoplastic lesions, who did not receive a definitive diagnosis following the initial EUS-FNA and subsequently underwent repeated EUS-FNA, were collected from the gastrointestinal endoscopy center of Qilu Hospital of Shandong University from January 2018 to October 2023. The ultrasonographic endoscopic images, pathology, and follow-up data were reviewed. Patients with confirmed diagnoses following repeated EUS-FNA were analyzed to determine the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of repeat EUS-FNA for tumor and non-neoplastic lesions. Results A total of 36 patients with space-occupying lesions in different parts were included in the study, and the final diagnosis was 80.6% (29/36) of tumor lesions and 19.4% (7/36) of non-tumor lesions. Among these, 34 patients received definitive diagnoses. The diagnostic sensitivity of repeated EUS-FNA for tumor was 82.8% (24/29), the specificity was 100.0% (7/7), the positive predictive value was 100.0% (24/24), the negative predictive value was 58.3% (7/12), and the accuracy was 86.1% (31/36). Conclusion Repeated EUS-FNA proves to be an effective and practical approach for cases where is suspicion of neoplastic lesions and the initial EUS-FNA pathology findings remain inconclusive.