Background and Aims

The tissue acquisition and diagnostic yield of cyst fluid cytology is low-to-moderate and rarely provides a specific diagnosis. The aim of this study was to compare the tissue acquisition and diagnostic tissue yield of microforceps biopsy (MFB) with cyst fluid cytology.

Methods

In this multicenter study, data of 42 patients who had cysts both aspirated by EUS-guided FNA (EUS-FNA) and biopsy specimens were then obtained with an MFB device, were collected. Cytology analysis of cyst fluid and histologic analysis of biopsy specimens were done. Acquisition yield was defined as percentage of patients with tissue present in the aspirate or biopsy. Diagnostic tissue yield was evaluated at 3 levels: the ability of differentiation between mucinous and/or nonmucinous cysts, detection of high risk for malignancy, and specific cyst type diagnosis.

Results

The mean patient age was 69 years. Sixteen pancreatic cysts (38.1%) were located in the head, 17 (40.5%) in the body, and 9 (21.4%) in the tail. The mean cyst size was 28.2 mm (12-60 mm); 25 of 42 (60%) were septated. The EUS-FNA tissue (fluid) acquisition yield was 88.1% (37/42). The MFB tissue acquisition yield was 90.4% (38/42). The diagnostic cytology yield to differentiate between mucinous and/or nonmucinous cysts was 47.6% (20/42), and the MFB histologic yield to differentiate between mucinous and/or nonmucinous cysts was 61.9% (26/42) (P = .188). The percentage of cysts at high risk for malignancy by cytology was 54.7% (23/42), and MFB was 71.5% (30/42) (P = .113). However, the ability of MFB to provide a specific cyst type diagnosis was 35.7% (15/42), and that for cytology was 4.8% (2/42) (P = .001). Surgical histology was concordant with that of MFB in 6 of 7 patients (85%), and with that of cytology in 1 of 7 patients (15%).

Conclusion

The cyst tissue acquisition yield for MFBs was 90%. Although cytology of cyst fluid and MFB were comparable in distinguishing mucinous and nonmucinous cysts and detecting cysts at high risk for malignancy, MFB was far superior to cytology for providing a specific cyst diagnosis.

中文翻译：

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微钳活检在胰腺囊肿诊断中的可行性和安全性

背景和目标

囊液细胞学的组织获取和诊断率低至中度，很少提供特异性诊断。这项研究的目的是比较微钳活检（MFB）与囊液细胞学的组织获取和诊断组织产量。

方法

在这项多中心研究中，随后收集了42名同时通过EUS引导的FNA抽吸（EUS-FNA）和活检标本的囊肿的患者的数据，并使用MFB装置进行了研究。进行了囊肿液的细胞学分析和活检标本的组织学分析。采集量定义为在抽吸或活检中存在组织的患者所占的百分比。在3个级别上评估了诊断性组织的产量：粘液性和/或非粘液性囊肿的分化能力，恶性高风险的检测以及特定囊肿类型的诊断。

结果

患者平均年龄为69岁。头部有16个（38.1％）胰腺囊肿，体内有17个（40.5％），尾部有9个（21.4％）。平均囊肿大小为28.2毫米（12-60毫米）；隔离了42个中的25个（60％）。EUS-FNA组织（流体）的采集率为88.1％（37/42）。MFB组织获得率为90.4％（38/42）。区分粘液性和/或非粘液性囊肿的诊断细胞学产率为47.6％（20/42），区分粘液性和/或非粘液性囊肿的MFB组织学产率为61.9％（26/42）（P  = .188） 。细胞学检查发现高恶性囊肿百分比为54.7％（23/42），MFB为71.5％（30/42）（P = .113）。但是，MFB提供特定囊肿类型诊断的能力为35.7％（15/42），而细胞学检查的能力为4.8％（2/42）（P  = .001）。手术组织学与7例中的6例（85％）的MFB一致，与7例中的1例（15％）的细胞学一致。

结论

MFB的囊肿组织采集率为90％。尽管囊肿液和MFB的细胞学在区分粘液性囊肿和非粘液性囊肿以及检测高恶性肿瘤囊肿方面具有可比性，但MFB在提供特定的囊肿诊断方面远胜于细胞学。