The Clinical Role Of EUS-FNA In The Diagnosis Of Pancreatic Tumors

Background With the continuous development of medical technology,the clinical detection rate of pancreatic space-occupying lesions has shown a significant increase.The different results obtained by different examination methods require clinicians to make timely and accurate results based on specific conditions.Judgment and processing.Traditional abdominal color Doppler ultrasound,CT and MRI can only make a preliminary diagnosis of the lesion through imaging,but it is still difficult to accurately diagnose the specific nature of the lesion.Early diagnosis of the nature of the lesion is an important part of the diagnosis and treatment of pancreatic diseases.It is an important prerequisite that affects the clinical prognosis of patients.Endoscopic ultrasonography guided fine needle aspiration(EUS-FNA)obtains a few cells or tissues of pancreatic lesions and performs cytological or pathological diagnosis.It has the advantages of small trauma,simple operation,safe and effective,and rapid diagnosis.Objective To investigate the effectiveness and safety of fine needle aspiration guided by endoscopic ultrasonography in the diagnosis of pancreatic cancer.Methods The patients who came to our department for EUS-FNA examination from May 2011 to March 2019 were selected as the observation objects,and the pathological results and follow-up status were used as the final diagnosis,and the diagnosis of endoscopic ultrasonography-guided fine needle aspiration biopsy was evaluated value.Results Among the 189 patients undergoing EUS-FNA puncture,133 were pancreatic cancer(pancreatic cancer group),including 22 cases confirmed by pathology after surgery(18 cases of pancreatic ductal adenocarcinoma,1 case of intraductal papillary mucinous carcinoma,and pancreatic carcinoma).There were 1 case of metastatic cancer,1 case of pancreatic cystadenocarcinoma,1 case of acinar cell carcinoma)and 111 cases of pancreatic cancer were found in clinical examination and died during follow-up;56 cases were non-pancreatic cancer(non-pancreatic cancer group).The EUS-FNA diagnostic cytopathological results showed 47 cases of atypical cells,25 cases of suspected cancer cells,20 cases of cancer cells,and 97 cases of no tumor cells.133 cases were confirmed to be pancreatic cancer by postoperative pathology and follow-up results.The results of cytopathological examination were as follows: 52 cases of tumor cells were not found,36 cases of atypical cells,25 cases of suspected cancer cells,and 20 cases of cancer cells.The diagnostic sensitivity(true positive rate)of EUS-FNA is 60.90%,the false positive rate is 19.64%,the specificity(true negative rate)is 80.36%,and the false negative rate is 39.10%.Combined with different cytopathological grading standards,that is,the diagnostic criteria are "different cells or suspicious cancer cells or cancer cells are found to be positive","suspected cancer cells or cancer cells are found to be positive",and "cancer cells are found to be positive" as the diagnostic criteria.The result of analysis showed that with the diagnostic criteria of "diagnosing abnormal cells or suspicious cancer cells or cancer cells all positive",EUS-FNA has the most significant efficacy in diagnosing pancreatic cancer,with a sensitivity of 50.38% and a specificity of 75.00%.Before 2017,there were 124 cases of EUS-FNA puncture and 91 cases were diagnosed as pancreatic cancer.The diagnostic sensitivity(true positive rate)of EUS-FNA puncture was 52.75%,the false positive rate was 21.21%,the specificity(true negative rate)was 78.79%,and the false negative rate is 47.25%.In 2018 and2019,there were 65 cases of EUS-FNA puncture,and 42 cases were diagnosed as pancreatic cancer.The diagnostic sensitivity(true positive rate)of EUS-FNA puncture was 78.57%,the false positive rate It was 17.39%,the specificity(true negative rate)was 82.61%,and the false negative rate was 21.43%.Both the sensitivity and specificity of EUS-FNA puncture diagnosis in 2018 and 2019 were higher than those of EUS-FNA puncture diagnosis before 2017,and the false positive rate and false negative rate of EUS-FNA puncture in 2018 and 2019 were both lower than 2017 Years ago,the false positive rate and false negative rate of EUS-FNA puncture were statistically significant(P<0.05).Among the 189 patients undergoing EUS-FNA puncture,116 were located in the head of the pancreas and 73 were located in the tail of the pancreas.EUS showed 145cases(76.7%)of solid lesions and 44 cases of cystic/cystic solid lesions.The EUS imaging findings of patients with pancreatic cancer showed heterogeneous hypoechoic light clusters in the pancreatic lesions,mostly solid masses,irregular tumor borders,and significant pancreatic duct expansion;EUS imaging findings of patients with non-pancreatic cancer showed pancreas Cystic solid lesions can be seen at the lesion site,the tumor boundary is relatively clear,and the pancreatic duct is mostly without significant dilation.The area under the ROC curve of EUS-FNA for the diagnosis of pancreatic cancer was 0.643(95%CI: 0.561～0.724).The efficacy of EUS-FNA in diagnosing pancreatic cancer is significantly improved(sensitivity is 50.38%,specificity is 75.00%).The complication rate of 189 patients after EUS-FNA was 6.88%(13 cases),mainly hyperamylaseemia and abdominal pain.Conclusion 1.EUS imaging of patients with pancreatic cancer mostly showed heterogeneous hypoechoic light clusters,mostly solid masses,irregular tumor borders,and significant pancreatic duct dilatation;EUS imaging of non-pancreatic cancer patients mostly showed For cystic solid lesions,the tumor boundary is relatively clear,and the pancreatic duct is mostly without significant dilation.2.The diagnostic sensitivity(true positive rate)of EUS-FNA is 60.90%,the positive predictive value is 64.29%,the specificity(true negative rate)is 80.36%,and the negative predictive value is 17.46%.3.The area under the ROC curve for the diagnosis of pancreatic cancer by EUS-FNA is 0.643(95%CI: 0.561～0.724).4.Using the combined cytological diagnostic criteria of different grades,the efficacy of EUS-FNA in diagnosing pancreatic cancer is significantly improved.5.EUS-FNA technology is safe,reliable,and has a low complication rate.