谭莉;周桂丽;戴梦华;孟芝兰;桂阳;孝梦甦;张璟;张青;刘赫;孟华;李建初;吕珂;
TAN Li;ZHOU Gui-li;DAI Meng-hua;MENG Zhi-lan;GUI Yang;XIAO Meng-su;ZHANG Jing;ZHANG Qing;LIU He;MENG Hua;LI Jian-chu;LYU Ke;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Ultrasound,Fuwai Hospital(Shenzhen),Chinese Academy of Medical Sciences &Peking Union Medical College;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical Col

• 1:中国医学科学院北京协和医学院北京协和医院超声医学科
• 2:中国医学科学院北京协和医学院阜外医院深圳医院超声医学科
• 3:中国医学科学院北京协和医学院北京协和医院基本外科
• 4:中国医学科学院北京协和医学院北京协和医院病理科

摘要(Abstract)：

目的评估超声引导经皮穿刺活检对胰腺占位性病变的诊断价值及安全性,对比分析细针抽吸活检(fine needle aspiration,FNA)和粗针穿刺活检(core needle biopsy,CNB)的诊断效力。方法回顾性分析2014年1月至2017年4月北京协和医院经影像学检查发现胰腺肿物并接受超声引导下经皮胰腺肿物活检患者的临床资料。按照穿刺方法不同分为FNA和CNB两组,每组随访至少6个月,根据手术病理、重复活检或随访的临床进展确定最终诊断,对比两种活检方法的灵敏度、特异度、阳性预测值、阴性预测值和准确度。结果共160例符合纳入和排除标准的患者入选本研究,其中FNA组95例,CNB组65例,超声引导经皮穿刺活检的总体灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为93.8%、100%、100%、64.0%、94.4%。CNB的灵敏度、阴性预测值和准确度稍高于FNA(94.7%比93.1%,72.7%比57.1%,95.4%比93.7%),但两种方法的灵敏度、特异度、阳性预测值、阴性预测值、准确度差异并无统计学意义。主要并发症2例(1.3%,2/160),包括1例急性胰腺炎和1例穿刺后针道种植。结论超声引导经皮穿刺活检对于胰腺占位性病变是一种有效、安全的诊断方法, FNA和CNB的诊断效力在本研究中差异并不显著。
Objective This study aimed to evaluate the diagnostic value of percutaneous ultrasound-guided(US-guided) biopsy for pancreatic neoplasms, and to compare the evaluation of fine needle aspiration(FNA) and core needle biopsy(CNB). Methods Data of consecutive patients who had percutaneous US-guided biopsies of pancreatic masses for the diagnosis of suspiciously malignant solid pancreatic masses in Peking Union Medical College Hospital between January 2014 and April 2017 were retrospectively analyzed. The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), and accuracy were evaluated based on the biopsy methods(FNA vs. CNB). The final diagnosis was determined according to a combination of follow-up(no shorter than 6 months) imaging, clinical course evaluation, repeated biopsy and/or surgical pathology. Results A total of 160 patients who met the inclusion and exclusion criteria were enrolled in this study, including 95 in the FNA group and 65 in the CNB group. The overall sensitivity, specificity, PPV, NPV, and accuracy of percutaneous US-guided biopsy were 93.8%, 100%, 100%, 64.0%, and 94.4%, respectively. The sensitivity, NPV, and accuracy of the CNB group were higher than those of FNA group(94.7% vs. 93.1%,72.7% vs. 57.1%,95.4% vs. 93.7%), but there was no statistical difference between the two groups. Two cases with major complications(1.3%, 2/160) were observed, including one acute pancreatitis and one tumor seeding. Conclusions Percutaneous US-guided biopsy is an effective and safe diagnostic method for pancreatic neoplasms. The current data do not suggest significant differences in the diagnostic efficacy of FNA and CNB.

关键词(KeyWords)： 超声;胰腺肿瘤;细针抽吸活检;粗针穿刺活检
ultrasound;pancreatic neoplasm;fine needle aspiration;core needle biopsy

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81873902);; 中国医学科学院医学与健康科技创新工程(2016-I2M-3-005)

作者(Authors): 谭莉;周桂丽;戴梦华;孟芝兰;桂阳;孝梦甦;张璟;张青;刘赫;孟华;李建初;吕珂;
TAN Li;ZHOU Gui-li;DAI Meng-hua;MENG Zhi-lan;GUI Yang;XIAO Meng-su;ZHANG Jing;ZHANG Qing;LIU He;MENG Hua;LI Jian-chu;LYU Ke;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Ultrasound,Fuwai Hospital(Shenzhen),Chinese Academy of Medical Sciences &Peking Union Medical College;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical Col

参考文献(References)：

• [1] D'Onofrio M,Beleù A,De Robertis R.Ultrasound-guided percutaneous procedures in pancreatic diseases:new techniques and applications[J].Eur Radiol Exp,2019,3:2.
• [2] Pitman MB,Layfield LJ,Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology:A review[J].Cancer Cytopathol,2014,122:399- 411.
• [3] Layfield LJ,Schmidt RL,Hirschowitz SL,et al.Signific-ance of the diagnostic categories “atypical” and “suspicious for malignancy” in the cytologic diagnosis of solid pancreatic masses[J].Diagn Cytopathol,2014,42:292- 296.
• [4] D'Onofrio M,De Robertis R,Barbi E,et al.Ultrasound-guided percutaneous fine-needle aspiration of solid pancreatic neoplasms:10-year experience with more than 2,000 cases and a review of the literature[J].Eur Radiol,2016,26:1801- 1807.
• [5] Erturk SM,Silverman S,Mortele K,et al.Percutaneous biopsy of abdominal masses using 25-gauge needles[J].Abdom Imaging,2010,35:70- 74.
• [6] Yang RY,Ng D,Jaskolka JD,et al.Evaluation of percutaneous ultrasound-guided biopsies of solid mass lesions of the pancreas:a center's 10-year experience[J].Clin Imaging,2015,39:62- 65.
• [7] Suzuki R,Irisawa A,Bhutani MS,et al.Prospective evaluation of the optimal number of 25-gauge needle passes for endoscopic ultrasound-guided fine-needle aspiration biopsy of solid pancreatic lesions in the absence of an onsite cytopathologist[J].Dig Endosc,2012,24:452- 456.
• [8] Jang DK,Lee SH,Lee JK,et al.Comparison of cytological and histological preparations in the diagnosis of pancreatic malignancies using endoscopic ultrasound-guided fine needle aspiration[J].Hepatob Pancreat Dis,2017,16:418- 423.
• [9] Qin SY,Zhou Y,Li P,et al.Diagnostic efficacy of cell block immunohistochemistry,smear cytology,and liquid-based cytology in endoscopic ultrasound-guided fine-needle aspiration of pancreatic lesions:a single-institution experi-ence[J].PLoS One,2014,9:e108762.
• [10] Itonaga M,Murata SI,Hatamaru K,et al.Diagnostic efficacy of smear plus liquid-based cytology for EUS-FNA of solid pancreatic lesions:A propensity-matched study[J].Medicine (Baltimore),2019,98:e15575.
• [11] Samir AE,Vij A,Seale MK,et al.Ultrasound-guided percutaneous thyroid nodule core biopsy:clinical utility in patients with prior nondiagnostic fine-needle aspirate[J].Thyroid,2012,22:461- 467.
• [12] Yeon JS,Baek JH,Lim HK,et al.Thyroid nodules with initially nondiagnostic cytologic results:the role of core-needle biopsy[J].Radiology,2013,268:274- 280.
• [13] Huang Y,Shi J,Chen YY,et al.Ultrasound-Guided Percutaneous Core Needle Biopsy for the Diagnosis of Pancreatic Disease[J].Ultrasound Med Biol,2018,44:1145- 1154.
• [14] Di SM,Lencioni R,Solmi L,et al.Ultrasound-Guided Fine Needle Biopsy of Pancreatic Masses:Results of a Multicenter Study[J].Am J Gastroenterol,1998,93:1329- 1333.
• [15] Paulsen SD,Nghiem HV,Negussie E,et al.Evaluation of imaging-guided core biopsy of pancreatic masses[J].AJR Am J Roentgenol,2006,187:769- 772.
• [16] Kahriman G,Ozcan N,Dogan S,et al.Percutaneous ultrasound-guided core needle biopsy of solid pancreatic masses:Results in 250 patients[J].J Clin Ultrasound,2016,44:470- 473.
• [17] Zech CJ,Helmberger T,Wichmann MW,et al.Large core biopsy of the pancreas under CT fluoroscopy control:results and complications[J].J Comput Assist Tomogr,2002,26:743- 749.
• [18] Karlson BM,Forsman CA,Wilander E,et al.Efficiency of percutaneous core biopsy in pancreatic tumor diagnosis[J].Surgery,1996,120:75- 79.
• [19] Matsubara J,Okusaka T,Morizane C,et al.Ultrasound-guided percutaneous pancreatic tumor biopsy in pancreatic cancer:a comparison with metastatic liver tumor biopsy,including sensitivity,specificity,and complications[J].J.Gastroenterol,2008,43:225- 232.
• [20] Zamboni GA,D'Onofrio M,Idili A,et al.Ultrasound-guided percutaneous fine-needle aspiration of 545 focal pancreatic lesions[J].AJR Am J Roentgenol,2009,193:1691- 1695.
• [21] Caturelli E,Rapaccini GL,Anti M,et al.Malignant seeding after fine-needle aspiration biopsy of the pancreas[J].Diagn Imaging Clin Med,1985,54:88- 91.
• [22] Tyng CJ,Almeida MF,Barbosa PN,et al.Computed tomography-guided percutaneous core needle biopsy in pancreatic tumor diagnosis[J].World J Gastroenterol,2015,21:3579- 3586.
• [23] Maturen KE,Nghiem HV,Marrero JA,et al.Lack of tumor seeding of hepatocellular carcinoma after percutaneous needle biopsy using coaxial cutting needle technique[J].AJR Am J Roentgenol,2006,187:1184- 1187.
• [24] Johnson DE,Pendurthi TK,Balshem AM,et al.Implica-tions of fine-needle aspiration in patients with resectable pancreatic cancer[J].Am Surg,1997,63:675-679;discussion 679- 680.
• [25] Hernandez LV,Bhutani MS,Eisner M,et al.Non-surgical tissue biopsy among patients with advanced pancreatic cancer:effect on survival[J].Pancreas,2009,38:289- 292.