摘要
目的评价内镜医师快速现场评估(ROSE)对内镜超声引导下不同穿刺类型获取组织行免疫组织化学(IHC)染色的胰腺实性病变的诊断价值。方法回顾2018年8月至2022年10月间北京协和医院内镜中心1573例行内镜超声引导下组织取样(EUS-TA)的胰腺实性病变病例,收集65例依赖IHC染色诊断患者的临床资料,其中胰腺神经内分泌肿瘤(PNET)46例,胰腺实性假乳头状瘤(SPT)13例,淋巴瘤及间叶源性肿瘤6例。根据EUS-TA术中有无内镜医师开展ROSE,将患者分为ROSE组(36例)和非ROSE组(29例);根据穿刺类型,进一步分为FNA-ROSE(26例)、FNB-ROSE(10例)、FNA-非ROSE(24例)、FNB-非ROSE(5例)亚组,比较两组及亚组间的诊断准确率及IHC成功率。采用二项logistic多因素回归分析ROSE及穿刺类型对诊断准确性和IHC成功率的影响。结果ROSE组与非ROSE组的患者年龄、性别、胆红素水平、CA19-9水平、病灶部位、病灶大小、诊断构成比、外科手术率等临床特征差异均无统计学意义。亚组间EUS病灶平均大小及穿刺针径、穿刺点位置、穿刺针道数的差异亦无统计学意义。ROSE组的诊断准确率为88.9%,非ROSE组为79.3%,两组比较差异有统计学意义(P=0.023)。FNA-ROSE组较FNA-非ROSE组诊断准确率高(88.5%比75.0%),但差异无统计学意义(P>0.100),FNB-ROSE组与FNB-非ROSE组的诊断准确率及各组的IHC成功率差异均无统计学意义。二项logistic多因素回归分析结果未发现影响诊断准确率的独立因素。结论内镜医师开展ROSE提高了EUS-TA在需要IHC明确诊断的胰腺实性病变中的诊断准确率,对于提升EUS-TA对该类疾病的诊断效率具有潜在价值。
Objective To evaluate the diagnostic value of rapid on-site evaluation(ROSE)performed by endoscopists for solid pancreatic lesions requiring tissue for immunohistochemistry(IHC)staining with different approach of endoscopic ultrasound-guided tissue acquisition(EUS-TA).Methods After screening 1573 cases who underwent EUS-TA operation at the Endoscopy Center of Peking Union Medical College Hospital between August 2018 and October 2022,a total of 65 cases of solid pancreatic lesions whose diagnosis rely on IHC staining was collected and summarized with clinical data of each case.Among 65 cases,there were 46 cases of pancreatic neuroendocrine tumors(PNETs),13 cases of pancreatic solid pseudo-papillary tumors(SPTs),and 6 cases of lymphomas and mesenchymal.Patients were categorized into ROSE group(36 cases)and non-ROSE group(29 cases)according to the presence or absence of endoscopists performed ROSE during EUS-TA operation.They were further divided into subgroups of FNA-ROSE(26 cases),FNB-ROSE(10 cases),FNA-non-ROSE(24 cases)and FNB-non-ROSE(5 cases)according to the type of EUS-TA.Diagnostic accuracy and IHC success rate were compared between different groups and subgroups.Binomial logistic multifactorial regression analysis was used to evaluate the influence of ROSE and EUS-TA type on diagnostic accuracy and IHC success rate.Results There were no statistically significant differences between ROSE group and non-ROSE group in terms of age,gender,bilirubin level,CA19-9 level,lesion site,lesion size,composition ratio of diagnosis,and surgical rate.The differences in mean size of lesions,needle gauge,location of puncturation,and number of needle pass between subgroups were not statistically significant.The diagnostic accuracy was 88.9%in ROSE group and 79.3%in non-ROSE group,and the difference between the two groups was statistically significant(P=0.023).The diagnostic accuracy of FNA-ROSE group was higher than that of FNA-non-ROSE group(88.5%vs 75.0%),but the difference was not statistically significant(P>0.100).The diff
作者
熊定堃
刘泳汝
冯云路
赵雨
吴晰
郭涛
蒋青伟
王强
伍东升
张晟瑜
杨莹韵
杨爱明
Xiong Dingkun;Liu Yongru;Feng Yunlu;Zhao Yu;Wu Xi;Guo Tao;Jiang Qingwei;Wang Qiang;Wu Dongsheng;Zhang Shengyu;Yang Yingyun;Yang Aiming(Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华胰腺病杂志》
CAS
2024年第1期39-44,共6页
Chinese Journal of Pancreatology
基金
中央高水平医院临床研究专项(2022-PUMCH-D-001,2022-PUMCH-A-177,2022-PUMCH-B-024,2022-PUMCH-C-063)。
关键词
胰腺实性肿瘤
免疫组织化学染色
快速现场评估
内镜超声引导下组织取样
Pancreatic solid tumor
Immunohistochemical stain
Rapid on-site evaluation
Endoscopic ultrasound-guided tissue acquisition
