超声内镜引导下穿刺活检对常规胃镜活检阴性病灶的诊断价值

doi:10.3969/j.issn.1006-7795.2018.05.007

首都医科大学学报 ›› 2018, Vol. 39 ›› Issue (5): 657-662.doi: 10.3969/j.issn.1006-7795.2018.05.007

超声内镜引导下穿刺活检对常规胃镜活检阴性病灶的诊断价值

郝晓雯, 孙秀静, 李鹏

首都医科大学附属北京友谊医院消化内科国家消化系统疾病临床医学研究中心北京市消化疾病中心首都医科大学消化病学系消化疾病癌前病变北京市重点实验室, 北京 100050

收稿日期:2018-07-31 出版日期:2018-09-21 发布日期:2018-10-20
通讯作者: 李鹏 E-mail:lipeng@ccmu.edu.cn
基金资助:
国家自然科学基金面上项目（81570507），国家科技部国家重点研发计划（2017YFC0113600），北京市科学技术委员会京津冀协同创新推动项目（Z171100004517009），北京市科学技术委员会创新品种临床研究及关键技术升级项目（Z161100001816033），北京市科学技术委员会（首都临床特色应用研究）（Z141107002514018），首都卫生发展科研专项项目（2016-1-2022）。

Role of endoscopic ultrasound(EUS)-guided targeted biopsy in conventional endoscopic biopsy negative lesions

Hao Xiaowen, Sun Xiujing, Li Peng

Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University;National Clinical Research Center for Digestive Diseases;Beijing Digestive Disease Center;Faculty of Gastroenterology, Capital Medical University;Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China

Received:2018-07-31 Online:2018-09-21 Published:2018-10-20
Supported by:
This study was supported by National Natural Science Foundation of China (81570507), National Key R&D Program of the Ministry of Science and Technology(2017YFC0113600), Beijing-Tianjin-Hebei Region Collaborative Innovation Promoting Project Founded by Beijing Science and Technology Commission (Z171100004517009), Clinical Research and Key Technology Upgrading Projects of Beijing Science and Technology Commission (Z161100001816033),Beijing Municipal Science & Technology Commission(Z141107002514018), Capital Health Research and Development of Special(2016-1-2022).

摘要/Abstract

摘要： 目的评估超声内镜（endoscopic ultrasound，EUS）引导下穿刺活检对常规胃镜活检阴性的食管、胃疾病的诊断有效性及安全性。方法本研究分析了2016年5月至2018年7月本院接诊的可疑存在食管、胃恶性肿瘤但常规胃镜活检阴性的患者进行超声内镜和超声内镜引导下穿刺活检的病理结果和随访情况，以病理结果和（或）随访情况为最终诊断，评价超声引导下穿刺活检的诊断价值。结果共16例患者纳入研究，16例患者中有8例（50%）穿刺活检病理明确诊断为恶性肿瘤（分别为3例食管鳞癌、2例胃腺癌、1例非霍奇金B细胞淋巴瘤、1例胃间质瘤，1例发现淋巴管内癌栓）；有3例患者发现可疑异型细胞，怀疑为恶性肿瘤（其中2例在随访时确诊为胃癌），剩余的5例患者穿刺病理考虑为炎性改变，与后续的手术病理和（或）随访结果一致。超声内镜引导下穿刺活检的灵敏度为100%，特异度为83.3%，阳性预测值为90.9%，阴性预测值为100%，符合率为93.8%，EUS引导下穿刺活检与最终诊断比较，总体一致性好（Kappa值0.86），无穿刺相关合并症。结论超声内镜引导下穿刺活检对提高常规胃镜活检阴性病灶的诊断率有效、安全，对于普通胃镜活检未能获得有效病理学依据的病变，推荐进行超声内镜引导下穿刺活检。

关键词: 超声内镜, 超声内镜引导下穿刺活检, 活检阴性

Abstract: Objective To evaluate the efficacy and safety of endoscopic ultrasound (EUS)-guided biopsy in the diagnosis of underlying malignancy in patients with suspicious esophageal and gastric cancer and negative mucosal biopsies. Methods A retrospective analysis was conducted in sixteen patients who have suspicious esophageal and gastric cancer but endoscopic biopsy was negative. EUS and EUS-guided biopsy were performed to all those patients from May 2016 to July 2018 in our hospital. Results Sixteen patients (5 male) aged 29-83 years[median (53.19±16.98) years] were included in this study. Malignancy was confirmed in 8/16 patients on histology, suspicious tumor cells were found in 3/16 patients (2 of the three patients were finally diagnosed as malignant tumor). The remaining five patients were diagnosed with benign diseases. EUS-guided biopsy showed a sensitivity of 100%, specificity of 83.3%, positive predictive value (PPV) of 90.9%, negative predictive value (NPV) of 100% and accuracy of 93.8%. The consistency of EUS-guided biopsy and final diagnosis was great (Kappa=0.86).There were no immediate or late complications. Conclusion EUS-guided targeted biopsy is a helpful and safe procedure in the diagnosis of esophageal and gastric tumors with negative endoscopic biopsies.

Key words: endoscopic ultrasound(EUS), EUS-guided biopsy, negative mucosal biopsies

中图分类号:

R445

郝晓雯, 孙秀静, 李鹏. 超声内镜引导下穿刺活检对常规胃镜活检阴性病灶的诊断价值[J]. 首都医科大学学报, 2018, 39(5): 657-662.

Hao Xiaowen, Sun Xiujing, Li Peng. Role of endoscopic ultrasound(EUS)-guided targeted biopsy in conventional endoscopic biopsy negative lesions[J]. Journal of Capital Medical University, 2018, 39(5): 657-662.

参考文献

[1] Okasha H H, Naguib M, EI Nady M, et al. Role of endoscopic ultrasound and endoscopic-ultrasound-guided fine-needle aspiration in endoscopic biopsy negative gastrointestinal lesions[J]. Endosc Ultrasound, 2017, 6(3):156-161.
[2] Sharma V, Rana S S, Bhasin D K. Diffuse gastric wall thickening:appearances can be deceptive[J].Clin Gastroenterol Hepatol, 2015, 13(8):e121-122.
[3] Rana S S, Bhasin D K, Rao C. et al. Endoscopic ultrasound-guided diagnosis and management of an unusual gastric submucosal lesion-gastric wall abscess[J]. Endoscopy, 2013, 45(suppl2):E136-E137.
[4] Kawano H, Ishii A, Kimura T, et al. IgG4-related disease manifesting the gastric wall thickening[J]. Pathol Int, 2016, 66(1):23-28.
[5] Aswakul P, Janyangdikul P, Prachayakul V. Thickened esophagus as an unusual manifestation of eosinophilic esophagitis[J].Dis Esophagus, 2016, 29(6):681-683.
[6] Thomas T, Kaye PV, Ragunath K, et al. Endoscopic-ultrasound-guided mural trucut biopsy in the investigation of unexplained thickening of esophagogastric wall[J].Endoscopy, 2009, 41(4):335-339.
[7] Schauer M, Peiper M, Theisen J, et al. Prognostic factors in patients with diffuse type gastric cancer (linitisplastica) after operative treatment[J]. Eur J Med Res, 2011,16(1):29-33.
[8] Jenssen C, Dietrich C F. Endoscopic ultrasound-guided fine-needle aspiration biopsy and trucut biopsy in gastroenterology-An overview[J].Best Pract Res Clin Gastroenterol, 2009, 23(5):743-759.
[9] 中国医学会消化内镜学分会超声内镜学组.中国内镜超声引导下细针穿刺临床应用指南[J].中华消化内镜杂志,2017,34(1):3-13.
[10] 夏璐,李晓露,程吉华,等. 超声内镜对常规内镜活检阴性胃壁增厚病变的诊断价值[J].中华消化内镜杂志, 2011,28(12):675-679.
[11] 叶颖剑,谭诗云,蔡欧.超声内镜下引导下细针穿刺活检术对胃镜下病理阴性皮革胃患者的诊断价值[J].中华胃肠外科杂志,2018,21(5):578-580.
[12] 吴伟,胡端敏.内镜超声引导下活检钳穿刺式活检对胃壁增厚病变的诊断价值[J].中华消化内镜杂志,2016,33(2):85-87.
[13] Aadam A A, Wani S, Amick A, et al.A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy[J].Endosc Int Open, 2016, 4(5):E497-505.
[14] Khan M A, Grimm I S, Ali B. A meta-analysis of endoscopic ultrasound-fine-needle aspiration compared to endoscopic ultrasound-fine-needle biopsy:diagnostic yield and the value of onsite cytopathological assessment[J].Endosc Int Open, 2017,5(5):E363-E375.
[15] Dumonceau J M, Deprez P H, Jenssen C, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology:European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline-Updated January 2017[J].Endoscopy,2017,49(7):695-714.

超声内镜引导下穿刺活检对常规胃镜活检阴性病灶的诊断价值

Role of endoscopic ultrasound(EUS)-guided targeted biopsy in conventional endoscopic biopsy negative lesions

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