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EUS-guided fine-needle biopsy sampling versus FNA in the diagnosis of subepithelial lesions: a large multicenter study.
Gastrointestinal Endoscopy ( IF 7.7 ) Pub Date : 2020-02-25 , DOI: 10.1016/j.gie.2020.02.021
Diogo T H de Moura 1 , Thomas R McCarty 2 , Pichamol Jirapinyo 2 , Igor B Ribeiro 3 , Victor K Flumignan 4 , Fedaa Najdawai 5 , Marvin Ryou 2 , Linda S Lee 2 , Christopher C Thompson 2
Affiliation  

Background and Aims

Although conventional EUS-guided FNA (EUS-FNA) has previously been considered first-line for sampling subepithelial lesions (SELs), variable accuracy has resulted in increased use of fine-needle biopsy (FNB) sampling to improve diagnostic yield. The primary aim of this study was to compare FNA versus FNB sampling for the diagnosis of SELs.

Methods

This was a multicenter, retrospective study to evaluate the outcomes of EUS-FNA and EUS-guided FNB sampling (EUS-FNB) of SELs over a 3-year period. Demographics, lesion characteristics, sensitivity, specificity, accuracy, number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell block accuracy, and adverse events were analyzed. Subgroup analyses were performed comparing FNA versus FNB sampling by location and diagnostic yield with or without ROSE. Multivariable logistic regression was also performed.

Results

Two hundred twenty-nine patients with SELs (115 FNA and 114 FNB sampling) underwent EUS-guided sampling. Mean patient age was 60.86 ± 12.84 years. Most lesions were gastric in location (75.55%) and from the fourth layer (71.18%). Cell block for FNB sampling required fewer passes to achieve conclusive diagnosis (2.94 ± 1.09 vs 3.55 ± 1.55; P = .003). The number of passes was not different for ROSE adequacy (P = .167). Immunohistochemistry was more able to be successfully performed in more FNB sampling samples (69.30% vs 40.00%; P < .001). Overall, sensitivity and accuracy were superior for FNB sampling versus FNA (79.41% vs 51.92% [P = .001] and 88.03% vs 77.19% [P = .030], respectively). On subgroup analysis, sensitivity and accuracy of FNB sampling alone was superior to FNA + ROSE (79.03% vs 46.67% [P = .001] and 87.25% vs 68.00% [P = .024], respectively). There was no significant difference in diagnostic yield of FNB sampling alone versus FNB sampling + ROSE (P > .05). Multivariate analysis showed no predictors associated with accuracy. One minor adverse event was reported in the FNA group.

Conclusions

EUS-FNB was superior to EUS-FNA in the diagnosis of SELs. EUS-FNB was also superior to EUS-FNA alone and EUS-FNA + ROSE. These results suggest EUS-FNB should be considered a first-line modality and may suggest a reduced role for ROSE in the diagnosis of SELs. However, a large randomized controlled trial is required to confirm our findings.



中文翻译:

EUS指导的细针穿刺活检采样与FNA对比诊断上皮下病变:一项大型的多中心研究。

背景和目标

尽管以前将常规EUS引导的FNA(EUS-FNA)视为上皮下病变(SELs)采样的第一线,但可变精度导致增加了细针穿刺活检(FNB)采样的使用,以提高诊断率。这项研究的主要目的是比较FNA与FNB采样对SEL的诊断。

方法

这是一项多中心回顾性研究,旨在评估3年内SEL的EUS-FNA和EUS指导的FNB抽样(EUS-FNB)的结果。人口统计学,病变特征,敏感性,特异性,准确性,穿针次数,快速现场评估(ROSE)的诊断充分性,细胞阻滞准确性和不良事件进行了分析。进行亚组分析,根据有无ROSE的位置和诊断率比较FNA和FNB采样。还进行了多变量逻辑回归。

结果

229名SEL患者(115 FNA和114 FNB采样)接受EUS指导的采样。平均患者年龄为60.86±12.84岁。多数病灶位于胃(75.55%),第四层(71.18%)。用于FNB采样的细胞块需要较少的通过次数即可完成结论性诊断(2.94±1.09对3.55±1.55;P  = 0.003)。ROSE充分性的通过次数没有不同(P  = .167)。免疫组织化学在更多的FNB采样样品中更能成功进行(69.30%对40.00%;P < .001)。总体而言,与FNA相比,FNB采样的灵敏度和准确性更高(79.41%vs 51.92%[ P  = .001]和88.03%vs 77.19%[ P = .030])。在亚组分析中,仅FNB采样的敏感性和准确性优于FNA + ROSE(分别为79.03%vs 46.67%[ P  = .001]和87.25%vs 68.00%[ P  = .024])。单独的FNB采样与FNB采样+ ROSE的诊断产率无显着差异(P > .05)。多变量分析显示没有与准确性相关的预测因素。在FNA组中报告了一个轻微的不良事件。

结论

在SELs的诊断中,EUS-FNB优于EUS-FNA。EUS-FNB也优于单独的EUS-FNA和EUS-FNA + ROSE。这些结果表明,EUS-FNB应该被认为是一线治疗方式,并且可能暗示ROSE在SELs诊断中的作用降低。但是,需要一项大型随机对照试验来证实我们的发现。

更新日期:2020-02-25
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