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不同细胞病理学分级标准对超声内镜引导下细针穿刺诊断胰腺癌的影响

孟海轮 李素文 宋育林 鲍峻峻 刘衡 梅俏

孟海轮, 李素文, 宋育林, 等. 不同细胞病理学分级标准对超声内镜引导下细针穿刺诊断胰腺癌的影响[J]. 临床肝胆病杂志, 2021, 37(2): 390-395. DOI: 10.3969/j.issn.1001-5256.2021.02.028
引用本文: 孟海轮, 李素文, 宋育林, 等. 不同细胞病理学分级标准对超声内镜引导下细针穿刺诊断胰腺癌的影响[J]. 临床肝胆病杂志, 2021, 37(2): 390-395. DOI: 10.3969/j.issn.1001-5256.2021.02.028
MENG HL, LI SW, SONG YL, et al. Effect of different cytopathological grading standards on the diagnosis of pancreatic cancer by endoscopic ultrasound-guided fine needle aspiration[J]. J Clin Hepatol, 2021, 37(2): 390-395. DOI: 10.3969/j.issn.1001-5256.2021.02.028
Citation: MENG HL, LI SW, SONG YL, et al. Effect of different cytopathological grading standards on the diagnosis of pancreatic cancer by endoscopic ultrasound-guided fine needle aspiration[J]. J Clin Hepatol, 2021, 37(2): 390-395. DOI: 10.3969/j.issn.1001-5256.2021.02.028

不同细胞病理学分级标准对超声内镜引导下细针穿刺诊断胰腺癌的影响

DOI: 10.3969/j.issn.1001-5256.2021.02.028
详细信息
    作者简介:

    孟海轮(1983—),男,副主任医师,主要从事消化内镜临床研究

    通讯作者:

    梅俏,meiqiao@hotmail.com

  • 利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突,特此声明。
  • 作者贡献声明:孟海轮、李素文、刘衡负责课题设计,资料分析,撰写论文;鲍峻峻、宋育林参与收集数据,修改论文;梅俏负责拟定写作思路,指导撰写文章并最后定稿。
  • 中图分类号: R735.9

Effect of different cytopathological grading standards on the diagnosis of pancreatic cancer by endoscopic ultrasound-guided fine needle aspiration

  • 摘要:   目的  探讨不同细胞病理学分级标准对超声内镜引导下细针穿刺(EUS-FNA)诊断胰腺癌效能的影响。  方法  收集2011年5月—2019年3月于安徽医科大学第一附属医院行EUS-FNA检查的256例胰腺占位患者的临床资料和胰腺细胞病理学诊断结果,以手术病理结果和随访情况作为最终诊断,评估影响EUS-FNA诊断效能的相关因素。计量资料两组间比较采用独立样本t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。应用受试者工作特征曲线(ROC曲线)评价不同细胞病理学分级标准对胰腺癌的诊断价值。  结果  剔除失访患者67例,共189例患者纳入研究,按巴氏细胞病理学标准,EUS-FNA诊断细胞病理学结果为异型细胞47例,疑癌细胞25例,癌细胞20例,未见肿瘤细胞97例。133例经术后病理和随访结果证实为胰腺癌,其中细胞病理学检查结果分别为:未见肿瘤细胞52例,异型细胞36例,疑癌细胞25例,癌细胞20例。EUS-FNA诊断胰腺癌的真阳性率为60.90%(81例),假阴性率为39.10%(52例);非胰腺癌56例,假阳性率为19.64%(11例),真阴性率为80.36%(45例)。EUS-FNA诊断胰腺癌的ROC曲线下面积为0.643(95% CI:0.561~0.724)。联合不同细胞病理学分级标准,分别以“发现异型细胞或可疑癌细胞或癌细胞均为阳性”“发现可疑癌细胞或癌细胞均为阳性”和“发现癌细胞为阳性”为诊断标准进行分析,结果显示,以“发现异型细胞或可疑癌细胞或癌细胞均为阳性”为诊断标准,EUS-FNA诊断胰腺癌的效能提高,敏感度为50.38%,特异度为75.00%。189例患者EUS-FNA术后并发症发生率为6.88%(13例),主要为高淀粉酶血症和腹痛。  结论  联合不同细胞病理学分级标准有助于提高EUS-FNA对胰腺癌的诊断效能。
  • 图  1  EUS-FNA诊断胰腺癌的ROC曲线

    表  1  胰腺癌与非胰腺癌组患者的临床特征比较

    指标 非胰腺癌组(n=56) 胰腺癌组(n=133) 统计值 P
    男[例(%)] 32(57.1) 85(63.9) χ2=0.765 0.382
    年龄(岁) 54.9±14.3 63.3±11.4 t=4.257 <0.001
    非甾体抗炎药用药史[例(%)] 1(1.8) 12(9.0) χ2=2.191 0.139
    糖尿病史[例(%)] 5(8.9) 17(12.8) χ2=0.569 0.451
    胰腺炎病史[例(%)] 14(25.0) 12(9.0) χ2=8.479 0.004
    WBC(109/L) 6.02±2.08 5.72±1.95 t=0.924 0.357
    RBC(1012/L) 4.32±0.64 4.16±0.63 t=1.588 0.114
    Hb(g/L) 124.16±20.47 122.11±17.94 t=0.686 0.494
    PLT(109/L) 214.61±88.11 186.88±80.94 t=2.086 0.038
    血清Ca2+(mmol/L) 2.28±0.12 2.27±0.18 t=0.158 0.875
    肌酐(μmol/L) 60.62±14.50 18.05±1.64 t=1.431 0.154
    尿素氮(mmol/L) 5.30(4.31~6.05) 5.23(3.83~6.49) U=1497.50 0.858
    Alb(g/L) 40.30±4.76 40.69±0.57 t=0.414 0.679
    TBil(μmol/L) 13.36(10.81~14.62) 19.85(12.15~29.78) U=1668.00 0.081
    DBil(μmol/L) 2.72(2.04~3.60) 4.24(3.76~16.86) U=1588.00 <0.001
    ALT(U/L) 16.00(14.00~18.00) 26.50(14.50~138.50) U=1819.50 0.072
    AST(U/L) 19.00(15.00~24.00) 27.50(17.00~74.00) U=1792.50 0.117
    GGT(U/L) 22.00(19.00~29.00) 48.00(22.00~315.50) U=1591.00 0.002
    ALP(U/L) 103.00(95.00~127.00) 115.00(66.00~347.50) U=3070.00 0.266
    CRP(mg/L) 4.74(0.79~62.18) 4.02(1.52~18.08) U=638.00 0.827
    Glu(mmol/L) 6.40±3.07 6.57±1.97 t=0.356 0.723
    脂肪酶(U/L) 43.00(25.00~80.00) 51.00(24.00~329.00) U=501.50 0.106
    淀粉酶(U/L) 72.00(61.00~80.00) 67.50(39.00~128.00) U=2166.00 0.223
    CA19-9(U/L) 59.94(10.19~192.30) 141.00(30.03~298.80) U=1590.50 <0.001
    CEA(mg/ml) 2.00(1.00~3.00) 3.00(2.00~5.00) U=1878.00 <0.001
    下载: 导出CSV

    表  2  胰腺癌与非胰腺癌组患者EUS特征比较

    项目 非胰腺癌组(n=56) 胰腺癌组(n=133) χ2 P
    病变部位(例) 0.015 0.904
      胰头部 34 82
      胰体尾部 22 51
    胰管扩张[例(%)] 18(32.1) 70(52.6) 6.649 0.010
    边界清晰[例(%)] 36(64.3) 34(25.6) 25.338 <0.001
    性质(例) 6.888 0.009
      囊性/囊实性 20 24
      实性 36 109
    低回声[例(%)] 43(76.8) 121(91.0) 6.915 0.009
    下载: 导出CSV

    表  3  EUS-FNA细胞学结果诊断胰腺癌效能分析

    EUS-FNA结果 AUC 敏感度(%) 特异度(%) Youden指数 Kappa(%) 阳性预测值(%) 阴性预测值(%) 假阴性率(%) 假阳性率(%)
    发现异型细胞或可疑癌细胞或癌细胞均为阳性 0.643 50.38 75.00 0.25 20.00 82.71 38.89 49.62 25.00
    发现可疑癌细胞或癌细胞均为阳性 0.606 30.08 91.07 0.21 14.53 88.89 35.42 69.92 8.92
    发现癌细胞为阳性 0.550 13.53 96.43 0.10 6.29 90.00 31.95 86.47 3.57
    下载: 导出CSV
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  • 收稿日期:  2020-08-16
  • 修回日期:  2020-10-16
  • 刊出日期:  2021-02-20
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