Pankreas lezyonlarının biyopsi uygulamalarında transabdominal ultrasonografi kılavuzluğunda perkütan çekirdek iğne biyopsi ve endoskopik ultrasonografi kılavuzluğunda aspirasyon biyopsi sonuçlarının değerlendirilmesi
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Tarih
2023
Yazarlar
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Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışmamızın amacı, 22 gauge iğne kullanılarak endoskopik ultrason kılavuzluğunda ince iğne aspirasyonunun (EUS-İİA) ve 18 gauge iğne kullanılarak transabdominal ultrason kılavuzluğunda çekirdek iğne biyopsisinin (US-ÇİB) pankreas lezyonlarının teşhisi için tanısal performanısını karşılaştırmaktı. Buradan yola çıkarak pankreas lezyon biyopsilerinin gerçekleştirileceği yöntemin seçimine katkı sağlanması amaçlanmıştır.
Gereç ve yöntemler: Kliniğimizde Ocak 2019 - aralık 2022 tarihleri arasında pankreas lezyonları nedeniyle US-ÇİB ve EUS-İİA yapılan hastaların verileri retrospektif olarak değerlendirildi. İşlem yöntemi, kullanılan iğne tipleri belirtildi. Arşivdeki patoloji ve sitoloji raporları değerlendirild. Biyopsi sonuçları benign, malign ve yetersiz olmak üzere 3 gruba ayrıldı.
Çalışmaya dahil edilen toplam 229 hastadan 89'una EUS kılavuzluğunda ince iğne aspirasyonu (EUS-İİA) ve 140'ına US kılavuzluğunda çekirdek iğne biyopsisi (US-ÇİB) uygulandı. Çalışmaya dahil edilen 229 hastadan 102'sinde cerrahi sonuçlarının patolojik değerlendirilmesi, metastatik lezyonlardan alınan biyopsi sonuçları ve takip bulguları vasıtasıyla tanısal doğruluğu kanıtlandı. Doğrulanan sonuçlar gerçek pozitifler ve gerçek negatifler olarak gruplara ayrıldı.
Bulgular: 229 hastaya biyopsi işlemi yapıldı (US kılavuzluğunda ÇİB, n = 140; EUS kılavuzluğunda İİA, n = 89).
Hastaların yaş ortalaması 66 (56-74) yıl iken %54,6’sı erkekti. Örneklerin elde edildiği lezyonların %16,6’sı 2 cm’den küçük iken %56,8’i 2-4 cm arasında ve geriye kalan %26,6’sı 4 cm’den büyüktü. Lezyonların %59,0’ı pankreasın baş-unsinat proçesinde, %24,5’i gövdesinde, %16,6’sı ise kuyruğunda idi. Lezyonların %76,9’u solid, %15,3’ü kistik ve %7,9’u kompleks idi. İncelenen örneklerin %55,5’inde biliyer dilatasyon, %44,5’inde damar invazyonu mevcuttu. Örneklerin %25,8’inde metastaz mevcut olup %22,3’ü karaciğere, %6,6’sı peritona ve %3,5’i akciğere idi. İncelenen örneklerin %86,5’i patolojik inceleme için yeterli düzeydi idi. Örneklerin patolojik sonucunun %62,0’ı malign, %24,5’i benign ve %13,5’i yetersiz numune olarak geldi.
Örneklerin 198'inde biyopsi işlemi başarıyla elde edildi (US-ÇİB, n = 135; EUS- İİA, n = 63). İşlemlerin 31'inde yetersiz örnek alımı geldi (US-ÇİB, n = 5; EUS-İİA, n = 26). US-ÇİB'nin doğruluk yüzdesi, yeterlilik oranı, ve sensitivitesi (sırasıyla %92.7, %96.4 ve %90.7) EUS-İİA'nınkine göre (%83.0, %70.8 ve %74.2) yüksek iken spesifiteleri eşitti (%100).
Her iki modalitenin tanı verimi (örnek alma başarısı) ve tanısal doğruluk oranları karşılatırıldı.
Tanı verimi, yöntemler arasında US-ÇİB'de EUS-İİA'ya göre daha üstün bulundu (sırasıyla %96.4, EUS-İİA'da ise %70.8 P<0.001). Ayrıca lezyon boyutu, yeri ve natürüne göre gruplara ayrıldıktan sonra karşılaştırmalar yapıldı. Lezyon boyutu <2 cm ve 2-4 cm olanlarda, baş-unsinat, gövde yerleşimi olanlarda, solid ve kistik natürlü olanlarda US-ÇİB yönteminde EUS-İİA'dan daha yüksek tanı verimi alındı. Bu açıdan boyutu >4 cm olan, kuyruk yerleşimli ve kompleks natürlü lezyonlarda istatiksel fark yoktu.
Tanısal doğruluk oranlarına geldikte ise US-ÇİB'nin doğru tanı koyma başarısı EUS-İİA'nundan daha başarılıydı (%92.7'e karşı %83).
Sonuç: Pankreas lezyonları için US-ÇİB'nin tanısal verimi ve tanısal doğruluğu EUS-İİA'nunkinden daha üstün bulunmuştur.
Purpose: The aim of our study was to compare the diagnostic performance of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) using a 22-gauge needle and transabdominal ultrasound-guided core needle biopsy (US-CNB) using an 18-gauge needle for the diagnosis of pancreatic lesions. From this point of view, it is aimed to contribute to the selection of the method in which pancreatic lesion biopsies will be performed. Materials and Methods: The data of patients who underwent US-CNB and EUS-FNA for pancreatic lesions in our clinic between January 2019 and December 2022 were evaluated retrospectively. The method of operation, the types of needles used were specified. Pathology and cytology reports in the archive were evaluated. Biopsy results were divided into 3 groups as benign, malignant and inadequate. Out of a total of 229 patients included in the study, 89 had EUS-guided fine needle aspiration (EUS-FNA) and 140 had US-guided core needle biopsy (US-CNB). In 102 of the 229 patients included in the study, the diagnostic accuracy was proven by pathological evaluation of surgical results, biopsy results from metastatic lesions, and follow-up findings. Confirmed results were grouped into true positives and true negatives. All procedures in the study were performed on human participants in accordance with national research committee standards and the 1964 Helsinki Declaration ethical guidelines. Approval was obtained by the local ethics committee (decision no: 2023/4376). Permission was obtained from the institutions for the retrospective analysis of the records. The procedures were performed by experienced endoscopists and interventional radiologists. Results: Biopsy was performed in 229 patients (US-CNB, n = 140; EUS-FNA, n = 89). While the mean age of the patients was 66 (56-74) years, 54.6% were male. While 16.6% of the lesions from which the samples were obtained were smaller than 2 cm, 56.8% were between 2-4 cm and the remaining 26.6% were larger than 4 cm. 59.0% of the lesions were in the head-uncinate process of the pancreas, 24.5% were in the body, and 16.6% were in the tail. 76.9% of the lesions were solid, 15.3% cystic, and 7.9% complex. Biliary dilatation was present in 55.5% of the samples examined, and vascular invasion was present in 44.5%. Metastases were present in 25.8% of the samples, 22.3% to the liver, 6.6% to the peritoneum and 3.5% to the lung. 86.5% of the samples examined were sufficient for pathological examination. Of the pathological results of the samples, 62.0% were malignant, 24.5% were benign, and 13.5% were insufficient samples. Biopsy was successfully obtained in 198 of the samples (US-CNB, n = 135; EUS-FNA, n = 63). Inadequate sampling was achieved in 31 of the procedures (US-CNB, n = 5; EUS-FNA, n = 26). While the accuracy, adequacy ratio, and sensitivity (92.7%, 96.4%, and 90.7%, respectively) of US-CNB were higher than that of EUS-FNA (83.0%, 70.8%, and 74.2%), their specificities were equal (100%). The diagnostic yield (sampling success) and diagnostic accuracy of both modalities were compared. Diagnostic yield was found to be superior in US-CNB than EUS-FNA among methods (96.4%, respectively, and 70.8% P<0.001 in EUS-FNA). In addition, comparisons were made after they were divided into groups according to the size, location and nature of the lesion. In patients with lesion size <2 cm and 2-4 cm, head-uncinate, trunk localization, and those with solid and cystic nature, the US-CNB method had higher diagnostic yield than EUS-FNA. In this respect, there was no statistical difference in lesions >4 cm in size, located in the tail, and complex in nature. When it comes to diagnostic accuracy, the accuracy of US-CNB was more successful than EUS-FNA (92.7% vs. 83%). Conclusion: The diagnostic yield and diagnostic accuracy of US-CNB for pancreatic lesions was superior to that of EUS-FNA.
Purpose: The aim of our study was to compare the diagnostic performance of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) using a 22-gauge needle and transabdominal ultrasound-guided core needle biopsy (US-CNB) using an 18-gauge needle for the diagnosis of pancreatic lesions. From this point of view, it is aimed to contribute to the selection of the method in which pancreatic lesion biopsies will be performed. Materials and Methods: The data of patients who underwent US-CNB and EUS-FNA for pancreatic lesions in our clinic between January 2019 and December 2022 were evaluated retrospectively. The method of operation, the types of needles used were specified. Pathology and cytology reports in the archive were evaluated. Biopsy results were divided into 3 groups as benign, malignant and inadequate. Out of a total of 229 patients included in the study, 89 had EUS-guided fine needle aspiration (EUS-FNA) and 140 had US-guided core needle biopsy (US-CNB). In 102 of the 229 patients included in the study, the diagnostic accuracy was proven by pathological evaluation of surgical results, biopsy results from metastatic lesions, and follow-up findings. Confirmed results were grouped into true positives and true negatives. All procedures in the study were performed on human participants in accordance with national research committee standards and the 1964 Helsinki Declaration ethical guidelines. Approval was obtained by the local ethics committee (decision no: 2023/4376). Permission was obtained from the institutions for the retrospective analysis of the records. The procedures were performed by experienced endoscopists and interventional radiologists. Results: Biopsy was performed in 229 patients (US-CNB, n = 140; EUS-FNA, n = 89). While the mean age of the patients was 66 (56-74) years, 54.6% were male. While 16.6% of the lesions from which the samples were obtained were smaller than 2 cm, 56.8% were between 2-4 cm and the remaining 26.6% were larger than 4 cm. 59.0% of the lesions were in the head-uncinate process of the pancreas, 24.5% were in the body, and 16.6% were in the tail. 76.9% of the lesions were solid, 15.3% cystic, and 7.9% complex. Biliary dilatation was present in 55.5% of the samples examined, and vascular invasion was present in 44.5%. Metastases were present in 25.8% of the samples, 22.3% to the liver, 6.6% to the peritoneum and 3.5% to the lung. 86.5% of the samples examined were sufficient for pathological examination. Of the pathological results of the samples, 62.0% were malignant, 24.5% were benign, and 13.5% were insufficient samples. Biopsy was successfully obtained in 198 of the samples (US-CNB, n = 135; EUS-FNA, n = 63). Inadequate sampling was achieved in 31 of the procedures (US-CNB, n = 5; EUS-FNA, n = 26). While the accuracy, adequacy ratio, and sensitivity (92.7%, 96.4%, and 90.7%, respectively) of US-CNB were higher than that of EUS-FNA (83.0%, 70.8%, and 74.2%), their specificities were equal (100%). The diagnostic yield (sampling success) and diagnostic accuracy of both modalities were compared. Diagnostic yield was found to be superior in US-CNB than EUS-FNA among methods (96.4%, respectively, and 70.8% P<0.001 in EUS-FNA). In addition, comparisons were made after they were divided into groups according to the size, location and nature of the lesion. In patients with lesion size <2 cm and 2-4 cm, head-uncinate, trunk localization, and those with solid and cystic nature, the US-CNB method had higher diagnostic yield than EUS-FNA. In this respect, there was no statistical difference in lesions >4 cm in size, located in the tail, and complex in nature. When it comes to diagnostic accuracy, the accuracy of US-CNB was more successful than EUS-FNA (92.7% vs. 83%). Conclusion: The diagnostic yield and diagnostic accuracy of US-CNB for pancreatic lesions was superior to that of EUS-FNA.
Açıklama
Anahtar Kelimeler
Pankreas, Endoskopik ultrason eşliğinde ince iğne aspirasyonu, Görüntü rehberliğinde biyopsi, Çekirdek iğne biyopsisi, Ultrasonografi, Endoskopik ultrasonografi, Pancreas, Endoscopic ultrasound-guided fine needle aspiration, Image guided biopsy, Core needle biopsy, Ultrasonography, Endoscopic ultrasonography
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Künye
Rzayev, F. (2023). Pankreas lezyonlarının biyopsi uygulamalarında transabdominal ultrasonografi kılavuzluğunda perkütan çekirdek iğne biyopsi ve endoskopik ultrasonografi kılavuzluğunda aspirasyon biyopsi sonuçlarının değerlendirilmesii. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Radyoloji Anabilim Dalı, Konya.
