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超声引导经皮穿刺活检对胰腺占位性病变的诊断价值:病例对照研究

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

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文章导航 > 协和医学杂志  > 2020 >  11(3): 289-295
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. 超声引导经皮穿刺活检对胰腺占位性病变的诊断价值:病例对照研究[J]. 协和医学杂志, 2020, 11(3): 289-295. doi: 10.3969/j.issn.1674-9081.20190209
引用本文: 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. 超声引导经皮穿刺活检对胰腺占位性病变的诊断价值:病例对照研究[J]. 协和医学杂志, 2020, 11(3): 289-295. doi: 10.3969/j.issn.1674-9081.20190209
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Li TAN, Gui-li ZHOU, Meng-hua DAI, Zhi-lan MENG, Yang GUI, Meng-su XIAO, Jing ZHANG, Qing ZHANG, He LIU, Hua MENG, Jian-chu LI, Ke LYU. Evaluation of Percutaneous Ultrasound-guided Biopsy for Pancreatic Neoplasms: A Case-control Study[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(3): 289-295. doi: 10.3969/j.issn.1674-9081.20190209
Citation: Li TAN, Gui-li ZHOU, Meng-hua DAI, Zhi-lan MENG, Yang GUI, Meng-su XIAO, Jing ZHANG, Qing ZHANG, He LIU, Hua MENG, Jian-chu LI, Ke LYU. Evaluation of Percutaneous Ultrasound-guided Biopsy for Pancreatic Neoplasms: A Case-control Study[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(3): 289-295. doi: 10.3969/j.issn.1674-9081.20190209
shu

超声引导经皮穿刺活检对胰腺占位性病变的诊断价值:病例对照研究

doi: 10.3969/j.issn.1674-9081.20190209
  • 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, 北京 100730

  • 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, 深圳 518057

  • 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, 北京 100730

  • 4.

    中国医学科学院 北京协和医学院 北京协和医院病理科, 北京 100730

基金项目: 

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

详细信息
    通讯作者:

    吕珂  电话:010-69155494,E-mail:lvke@163.com

    谭莉、 周桂丽对本文同等贡献

    谭莉、 周桂丽对本文同等贡献

  • 中图分类号: R445;R446

Evaluation of Percutaneous Ultrasound-guided Biopsy for Pancreatic Neoplasms: A Case-control Study

  • 1.

    Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of Ultrasound, Fuwai Hospital(Shenzhen), Chinese Academy of Medical Sciences & Peking Union Medical College, Shenzhen 518057, China

  • 3.

    Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 4.

    Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

    摘要
  • 摘要:   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。
    Abstract:   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.
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    谭莉、 周桂丽对本文同等贡献
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  • 图  1  一例患者因胰头占位行超声引导细针抽吸活检

    Ａ.二维超声示胰腺钩突部低回声, 大小约2.6cm×2.9cm×1.7cm, 边界欠清, 主胰管增宽(箭头);Ｂ.超声造影示肿块动脉期周边轻度增强, 呈边界欠清的低增强区(箭头);Ｃ. 超声造影示静脉期肿块内造影剂廓清;D、E.穿刺活检涂片及新柏氏液基细胞学检测均提示找到恶性肿瘤细胞, 符合导管腺癌

    下载: 全尺寸图片 幻灯片

    图  2  一例患者因胰头占位行超声引导下粗针穿刺活检

    Ａ.二维超声示胰头部低回声, 大小约5.9cm×5.1cm×4.8cm, 形态不规则, 边界欠清, Ｂ.彩色多普勒超声示肿块内部散在条状血流, Ｃ: 超声造影示肿块动脉期不均匀增强(箭头), Ｄ.超声造影示肿块静脉期同步减退, 呈边界欠清的低增强区, Ｅ.穿刺活检提示找到恶性肿瘤细胞, 符合导管腺癌

    下载: 全尺寸图片 幻灯片

    表  1  160例超声引导下经皮穿刺活检胰腺占位病变患者一般临床特征比较

    指标 FNA(n=95) CNB(n=65) t/u/x2值 P值
    男/女(n) 54/41 35/30 0.140 0.708
    年龄(x±s, 岁) 56.1±11.8 54.1±12.0 1.056 0.291
    病灶大小[M(P25, P75), cm] 5(3.85, 6.5) 4.75(4.03, 5.68) 0.285 0.659
    病灶部位[n(％)] 3.380 0.185
        胰头/钩突部 41(43.2) 36(55.4)
        胰体尾部 49(51.6) 24(36.9)
        不确切 5(5.3) 5(7.7)
    病灶结构[n(％)] 0.000 0.977
        实性 82(86.3) 56(86.2)
        囊实性 13(13.7) 9(13.8)
    FNA:细针抽吸活检, CNB:粗针穿刺活检
    下载: 导出CSV

    表  2  FNA组细胞学诊断与最终诊断对照

    细胞学诊断 例数 最终诊断 例数
    恶性(Ⅵ级) 45 恶性 45
        导管腺癌 42     导管内乳头状黏液瘤* 1
        随访恶性 41
        神经内分泌癌 1     随访恶性 1
        未提示病理类型 2     随访恶性 2
    可疑恶性(Ⅴ级) 18 恶性 18
        导管腺癌 3     胆管癌 1
        随访恶性 2
        未提示病理类型 15     囊腺癌 1
        随访恶性 14
    肿瘤性病变(Ⅳ级) 11 恶性 11
        神经内分泌肿瘤 5     神经内分泌肿瘤* 2
        实性假乳头状瘤 1
        导管腺癌* 1
        随访恶性 1
        实性假乳头瘤或神经内分泌
        肿瘤    		 2     腺泡细胞癌* 1
        随访恶性 1
        导管内乳头状黏液瘤 1     随访恶性* 1
        黏液性肿瘤 1     随访恶性* 1
        未提示病理类型 2     随访恶性* 2
    非典型(Ⅲ级) 7 恶性 7
        神经内分泌肿瘤* 2
        随访恶性 6
    未见恶性(Ⅱ级) 14 良性 8
        慢性胰腺炎* 3
        自身免疫性胰腺炎＃ 5
    恶性 6
        转移性透明肾细胞癌* 1
        导管腺癌 1
        神经内分泌肿瘤* 1
        随访恶性 3
    FNA:同表1;*手术病理证实；#重复穿刺及临床随访证实
    下载: 导出CSV

    表  3  CNB组组织学诊断与最终诊断对照

    组织学诊断 例数 最终诊断 例数
    恶性 50 恶性 50
        导管腺癌 39     随访恶性* 39
        神经内分泌肿瘤 4     神经内分泌肿瘤* 2
        随访恶性 2
        导管内乳头状黏液瘤 1     随访恶性 1
        神经内分泌肿瘤或实性假乳头
          状瘤    		 1     随访恶性 1
        黏液性肿瘤或导管内乳头状
          黏液瘤    		 1     腺泡细胞癌 1
        腺泡细胞癌 1     随访恶性 1
        未提示病理类型 3     弥漫大Ｂ细胞淋巴瘤* 1
        随访恶性 2
    异型细胞 4 恶性 4
        未提示病理类型 4     随访恶性 4
    良性 9 恶性 2
        随访恶性 2
    良性 7
        慢性胰腺炎# 3
        自身免疫性胰腺炎* 3
        朗格汉斯细胞组织细胞增生症# 1
    取材不佳 2 良性# 1
    恶性* 1
        随访恶性* 1
    CNB: 同表1;*手术病理证实:#临床随访证实；†重复穿刺及临床随访证实
    下载: 导出CSV

    表  4  超声引导穿刺活检的诊断效力[HR(95％CI)，％]

    评估指标 FFNA(ｎ＝95) CNB(ｎ＝65) P值
    灵敏度 93.1(８5.８~96.８) 94.7(８5.6~9８.6) ０.9649
    特异度 100(67.6~100) 100(67.6~100) >0.9999
    阳性预测值 100(95.5~100) 100(93.4~100) >０.9999
    阴性预测值 57.1(32.6~7８.6) 72.7(43.4~9０.3) ０.6766
    准确度 93.7(８6.9~97.1) 95.4(８7.3~98.7) ０.9131
    FNA、CNB:同表1;
    下载: 导出CSV
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