CAJ | 학술논문

目的探讨超声内镜引导下细针穿刺(EUS-FNA)物行不同细胞学检查方法对胰腺占位性病变的诊断价值.方法前瞻性研究广西医科大学第一附属医院2012年3月至2013年6月收治的胰腺实性占位性病变72例,均行超声内镜引导下细针穿刺活检取材,分别行常规涂片、液基涂片及细胞块结合免疫组化检查.结果 72例患者中,最终确诊胰腺肿瘤61例,包括胰腺癌55例、胰腺假乳头状瘤2例、胰腺内分泌肿瘤4例;良性病变11例,包括慢性胰腺炎4例、胰腺结核2例、胰腺炎4例、黏液性囊腺瘤1例.常规涂片、液基涂片和细胞块结合免疫组化对胰腺肿瘤的诊断敏感度分别为68.9％ (42/61)、75.4％ (46/61)和90.2％ (55/61),特异度均为100.0％,准确率分别为73.6％(53/72)、79.2％ (57/72)和91.7％ (66/72),细胞块结合免疫组化诊断准确率高于常规涂片细胞学及液基细胞学(P均＜0.05).术后患者均无出血、感染、急性胰腺炎等并发症.结论 EUS-FNA是一种安全有效的诊断胰腺占位病变的方法,具有高敏感度和特异度.EUS-FNA细胞块结合免疫组化有助于胰腺实性占位病变的定性诊断和组织学分型诊断,对治疗方案的选择有较大的临床应用价值.
목적 탐토초성내경인도하세침천자(EUS-FNA)물행불동세포학검사방법대이선점위성병변적진단개치.방법 전첨성연구엄서의과대학제일부속의원2012년3월지2013년6월수치적이선실성점위성병변72례,균행초성내경인도하세침천자활검취재,분별행상규도편、액기도편급세포괴결합면역조화검사.결과 72례환자중,최종학진이선종류61례,포괄이선암55례、이선가유두상류2례、이선내분비종류4례;량성병변11례,포괄만성이선염4례、이선결핵2례、이선염4례、점액성낭선류1례.상규도편、액기도편화세포괴결합면역조화대이선종류적진단민감도분별위68.9％ (42/61)、75.4％ (46/61)화90.2％ (55/61),특이도균위100.0％,준학솔분별위73.6％(53/72)、79.2％ (57/72)화91.7％ (66/72),세포괴결합면역조화진단준학솔고우상규도편세포학급액기세포학(P균＜0.05).술후환자균무출혈、감염、급성이선염등병발증.결론 EUS-FNA시일충안전유효적진단이선점위병변적방법,구유고민감도화특이도.EUS-FNA세포괴결합면역조화유조우이선실성점위병변적정성진단화조직학분형진단,대치료방안적선택유교대적림상응용개치.
Objective To evaluate the diagnostic value of the cell block (CB) with immunostaining method by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy for pancreatic lesions.Methods A total of 72 patients with pancreatic lesions underwent EUS-FNA at the First Affiliated Hospital of Guangxi Medical University from March 2012 to June 2013.The EUS-FNA samples of all patients were processed by conventional smear cytology,liquid-based cytology (LBC) and the cell block with immunostaining.Results There were 61 pancreatic patients who were finally diagnosed as having pancreatic tumors,including 55 cases of pancreatic cancer,2 pancreatic solid pseudopapillary tumor,4 pancreatic endocrine tumors (PETs),and 11 benign lesions:4 chronic pancreatitis,2 pancreatic tuberculosis,4 pancreatitis and 1 pancreatic mucinous cystadenoma.The diagnostic sensitivity of conventional smear cytology,liquid-based cytology and cell block with immuno-staining method were 68.9％ (42/61),75.4％ (46/61) and 90.2％ (55/61),respectively.The diagnostic specificity of three methods were all 100.0％.The diagnostic accuracy rates were 73.6％ (53/72),79.2％ (57/72) and 91.7％ (66/72),respectively.The diagnostic accuracy rate of the cell block with immunostaining was higher than those of conventional smear cytology (P ＜ 0.05) and the liquid-based cytology (P ＜ 0.05).Conclusion Endoscopic ultrasound-guided fine-needle aspiration is a safe and effective method with high sensitivity and specificity in the diagnosis of pancreatic lesions.Cell block method combining immunohistochemistry helps to increase the diagnosis and histological diagnosis of pancreatic lesions.The cell block has a greater clinical value in the diagnosis of pancreatic lesions.