CAJ | 학술논문

目的探讨超声内镜引导下细针穿刺活组织检查(EUS-FNA)对上消化道毗邻不明起源肿物诊断的有效性和安全性.方法回顾性分析因上消化道毗邻不明起源肿物行EUS-FNA的37例患者,细针穿刺物行病理组织学及细胞学检查,做出EUS-FNA诊断,并以手术或随访结果为最终诊断,判断EUS-FNA诊断的准确性,采用Fisher确切概率法及多因素Logistic回归分析方法筛检有价值的超声内镜影像学特点.结果 37例患者中,35例(94.6％)经细针穿刺获得诊断所需组织.所有患者均获最终诊断,6例行手术证实,余31例经电话随访获得.最终诊断为恶性肿瘤25例,EUS-FNA确诊了其中的23例.EUS-FNA对确诊恶性病变的敏感度、特异度、阳性预测值、阴性预测值分别为92.0％、100.0％、100.0％、85.7％.最终诊断为非恶性疾病12例(其中结核4例),EUS-FNA仅确诊其中4例.未筛选出对诊断病变良恶性有价值的超声内镜影像学特点.所有患者均未出现严重并发症.结论 EUS-FNA是诊断上消化道毗邻不明起源肿物安全有效的方法,对鉴别此类病变的良恶性敏感度较好,但对非恶性疾病的定性诊断价值有限.结核是中国上消化道毗邻不明起源肿物的常见非恶性病因.
목적 탐토초성내경인도하세침천자활조직검사(EUS-FNA)대상소화도비린불명기원종물진단적유효성화안전성.방법 회고성분석인상소화도비린불명기원종물행EUS-FNA적37례환자,세침천자물행병리조직학급세포학검사,주출EUS-FNA진단,병이수술혹수방결과위최종진단,판단EUS-FNA진단적준학성,채용Fisher학절개솔법급다인소Logistic회귀분석방법사검유개치적초성내경영상학특점.결과 37례환자중,35례(94.6％)경세침천자획득진단소수조직.소유환자균획최종진단,6례행수술증실,여31례경전화수방획득.최종진단위악성종류25례,EUS-FNA학진료기중적23례.EUS-FNA대학진악성병변적민감도、특이도、양성예측치、음성예측치분별위92.0％、100.0％、100.0％、85.7％.최종진단위비악성질병12례(기중결핵4례),EUS-FNA부학진기중4례.미사선출대진단병변량악성유개치적초성내경영상학특점.소유환자균미출현엄중병발증.결론 EUS-FNA시진단상소화도비린불명기원종물안전유효적방법,대감별차류병변적량악성민감도교호,단대비악성질병적정성진단개치유한.결핵시중국상소화도비린불명기원종물적상견비악성병인.
Objective To explore the efficacy and safety of endoscopic ultrasorund-guided fineneedle aspiration (EUS-FNA) in the diagnosis of unknown lesions adjacent to the upper gastrointestinal tract.Methods Thirty-seven patients with unknown lesions adjacent to the upper gastrointestinal tract were retrospectively analyzed.Fine needle aspirated tissues underwent pathological and cytological examination and EUS-FNA diagnosis were established.The accuracy of EUS-FNA diagnosis was evaluated and the final diagnosis was made according to surgical pathological diagnosis and follow-up.Fisher's exact test and multivariate Logistic regression analysis were performed to screen the valuable endoscopic ultrasonography imaging features.Results Among 37 patients,enough diagnostic needed tissues of 35 patients (94.6 ％) were acquired through fine needle aspiration.All patients were eventually diagnosed.Six cases were confirmed by surgical pathological diagnosis and the other 31 cases were obtained through telephone follow-up.Twenty-five cases were diagnosed as malignant carcinoma,of whom 23 cases were diagnosed by EUS-FNA.The sensitivity,specificity,positive predictive value,negative predictive value of EUS-FNA in malignant lesions diagnosis were 92.0％,100.0％,100.0％,and 85.7％,respectively.Twelve cases were diagnosed as benign diseases (four cases as tuberculosis),only four cases of those were diagnosed by EUS-FNA.The valuable endoscopic ultrasonography imaging features for diagnosis of benign and malignant lesions were not screened out.There were no severe complications in all patients.Conclusions EUS-FNA is a safe and effective method in the diagnosis of unknown lesions adjacent to the upper gastrointestinal tract.The sensitivity of differencing malignant and benign lesions was better.However the value for the diagnosis of nonmalignant disease was limited.In China,tuberculosis is a common nonmalignant cause of unknown lesions adjacent to upper gastrointestinal tract.