超声内镜引导国产细针型激光共聚焦显微内镜诊断消化道及周围肿瘤的初探

A preliminary study on endoscopic ultrasound‑guided needle‑based confocal laser endomicroscopy in the diagnosis of gastrointestinal and peripheral tumors

摘要:

目的 探索超声内镜引导国产细针型激光共聚焦显微内镜（needle‑based confocal laser endomicroscopy，nCLE）对消化道及周围肿瘤的诊断价值。方法 前瞻性纳入2024年6月至11月于武汉市第四医院就诊经影像学诊断为消化道及周围肿瘤的患者。所有患者在超声内镜引导下采用19 G穿刺针穿刺病灶，通过穿刺针道置入nCLE探头，获取共聚焦图像并进行诊断，观察结束后对病灶部位实施超声内镜引导细针穿刺抽吸/活检术（endoscopic ultrasound‑guided fine‑needle aspiration/biopsy ，EUS‑FNA/FNB）以获取组织进行组织病理学检查，并观察操作中有无并发症发生。最终临床诊断以手术病理或EUS‑FNA/FNB病理结果为标准并结合影像学综合判断。结果 共纳入10例患者，经nCLE诊断为胰腺浆液性囊腺瘤2例、胰腺黏液性囊性肿瘤伴上皮内瘤变1例、胰腺导管内乳头状黏液性肿瘤1例、胰腺炎性病变1例和恶性病变5例。最终临床诊断结果为胰腺浆液性囊腺瘤2例、胰腺黏液性囊性肿瘤1例、胰腺结核1例、胰腺导管内乳头状黏液性肿瘤2例（1例伴恶变）、胰腺导管腺癌伴腹膜转移1例、肝胆管细胞癌并肝门淋巴结转移癌1例、肺鳞癌纵隔淋巴结转移1例、结肠腺癌1例。所有患者的nCLE诊断结果与最终临床诊断结果相符。1例患者在进行nCLE和EUS‑FNA检查后出现囊腔内出血，无需治疗。结论 超声内镜引导国产nCLE在消化道及周围肿瘤的诊疗过程中，安全有效，值得临床应用。

Abstract:

Objective To evaluate the diagnostic utility of a domestically produced needle-based confocal laser endoscopy (nCLE) system guided by endoscopic ultrasonography (EUS) for gastrointestinal and adjacent tumors. Methods In this prospective study, patients with radiologically identified gastrointestinal or peri-intestinal tumors at Wuhan Fourth Hospital from June to November 2024 underwent EUS-guided puncture with a 19-gauge needle, followed by nCLE probe insertion for real-time imaging. Histological specimens was obtained by concurrent EUS-guided fine-needle aspiration/biopsy (EUS-FNA/FNB), whilst any complication during the procedure was monitored. The final clinical diagnosis integrated surgical pathology, EUS-FNA/FNB pathological results and imaging findings. Results Among the 10 patients included in the study, nCLE diagnoses included 2 cases of pancreatic serous cystic neoplasm, 1 case of pancreatic mucinous cystic neoplasm with intraepithelial neoplasia, 1 case of intraductal papillary mucinous neoplasm, 1 case of pancreatic inflammatory lesion, and 5 cases of malignant lesions. The final clinical diagnoses were 2 cases of pancreatic serous cystic neoplasm, 1 pancreatic mucinous cystic neoplasm, 1 pancreatic tuberculosis, 2 intraductal papillary mucinous neoplasm (1 with malignant transformation), 1 pancreatic ductal adenocarcinoma with peritoneal metastasis, 1 cholangiocarcinoma with hilar lymph node metastasis, 1 pulmonary squamous cell carcinoma with mediastinal lymph node metastasis, and 1 colonic adenocarcinoma. The nCLE diagnostic findings were consistent with the final clinical diagnoses in all patients. One patient developed intracystic bleeding after the nCLE and EUS-FNA procedures, resolved without intervention. Conclusion EUS-guided domestically produced nCLE is safe and effective in the diagnosis of gastrointestinal and peripheral tumors, demonstrating promising clinical applicability.