超声内镜引导细针穿刺抽吸术诊断35例前列腺疾病的回顾性分析

Retrospective analysis of 35 cases of endoscopic ultrasound‑guided fine‑needle aspiration for prostate diseases

摘要:

目的 探讨超声内镜引导细针穿刺抽吸术（endoscopic ultrasound‑guided fine‑needle aspiration，EUS‑FNA）诊断前列腺疾病的可行性和安全性。方法 回顾性分析2010年2月至2018年3月在武汉市第四医院或襄阳市中心医院首次接受前列腺EUS‑FNA患者的临床及病理资料。主要观察指标包括EUS‑FNA的病理诊断结果、诊断准确率及穿刺相关并发症发生情况。同时根据穿刺针规格（19 G与22 G）进行分组，比较两种穿刺针在病理标本获取质量及并发症发生率方面的差异。结果 35例患者年龄67（57，75）岁，前列腺体积37.8（31.8，54.0）mL。EUS‑FNA初次病理诊断原发性前列腺癌17例（48.6%），转移癌1例（2.8%），多发性骨髓瘤累及前列腺1例（2.8%），直肠间质瘤累及前列腺1例（2.8%），脓肿2例（5.7%），前列腺增生6例（17.1%），正常前列腺5例（14.3%），未获得明确病理诊断2例（5.7%）。1年后30例（85.7%）患者完成随访并获得最终诊断，穿刺未获得明确病理诊断的2例患者，在随访中最终确诊为前列腺癌，余28例患者的最终诊断与最初穿刺结果一致，EUS‑FNA总体诊断准确率为93.3%（28/30，95%CI：78.7%~98.2%）。共5例（14.3%）出现轻微穿刺相关并发症，均经处理后好转，未发生严重不良事件。19 G穿刺针和22 G穿刺针在病理诊断获得率和并发症发生率方面差异无统计学意义（P0.05）；19 G穿刺针取材标本在免疫组化检测可行性方面较22 G穿刺针更高，但差异无统计学意义（P=0.084）；在Gleason评分可行性方面，19 G穿刺针优于22 G穿刺针，差异有统计学意义（P0.001）。结论 EUS‑FNA用于前列腺疾病的诊断具有良好的可行性和安全性，对前列腺癌有较高的诊断价值。19 G穿刺针在获取标本质量方面优于22 G穿刺针。

Abstract:

Objective To explore the feasibility and safety of endoscopic ultrasound‑guided fine‑needle aspiration (EUS‑FNA) for diagnosing prostate diseases. Methods A retrospective analysis was conducted on the clinical and pathological data of patients who underwent EUS‑FNA for the first time at Wuhan Fourth Hospital and Xiangyang Central Hospital between February 2010 and March 2018. Primary outcomes included the pathological diagnostic results, diagnostic accuracy, and procedure‑related complications of EUS‑FNA. Patients were grouped by needle gauge (19 G VS 22 G) to compare specimen adequacy and complication incidence. Results Thirty‑five patients were aged 67 (57, 75) years, with prostate volumes of 37.8 (31.8, 54.0) mL. Initial EUS‑FNA pathological diagnosis revealed primary prostate cancer in 17 cases (48.6%), metastatic cancer in 1 case (2.8%), multiple myeloma with prostatic involvement in 1 case (2.8%), rectal stromal tumor with prostatic involvment in 1 case (2.8%), abscess in 2 cases (5.7%), benign prostatic hyperplasia in 6 cases (17.1%), normal prostate in 5 cases (14.3%), and no definitive pathological diagnosis in 2 cases (5.7%). At 1‑year follow‑up, 30 patients (85.7%) had final diagnosis. The two initially non‑diagnostic cases were ultimately confirmed as primary prostate cancer. The final diagnoses of the remaining 28 patients were consistent with the initial biopsy results. The overall diagnostic accuracy of EUS‑FNA was 93.3% (28/30, 95%CI: 78.7%‑98.2%). Minor complications occurred in 5 patients (14.3%) and resolved with conservative management, and no serious adverse events occurred. There was no statistically significant difference in the pathological diagnosis success rate and incidence of complications between 19 G and 22 G puncture needles (P0.05). The feasibility of immunohistochemical testing with 19 G puncture needle specimens was superior to the 22 G puncture needle specimens, but the difference was not statistically significant (P=0.084), while in terms of the feasibility of Gleason score, 19 G puncture needle was superior to 22 G punture needle with signifcant difference (P0.001). Conclusion EUS‑FNA is a feasible and safe technique for the diagnosis of prostate diseases and has high diagnostic value for prostate cancer. In this study, the 19 G puncture needle provides superior specimen quality compared with the 22 G puncture needle.