Effectiveness Analysis Of Needle-based Confocal Laser Microendoscopy Assisted Fine Needle Aspiration On Solid Lesions Around The Gastrointestinal Tract Under Ultrasound Endoscopic Guidance

Purpose: To evaluate the diagnostic value of needle-based confocal endoscopy(nCLE)combined with endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)in the diagnosis of solid space-occupying lesions in the pancreas and mediastinum.Material and method:Patients with solid mass such as pancreas and mediastinum who were diagnosed by imaging at Shengjing Hospital Affiliated to China Medical University from March 2019 to February 2023 and required EUS-FNA were collected.The patients were divided into a study group and a control group according to the inclusion criteria and whether confocal endoscopy was used.All patient punctures were performed by the same senior sonographer,and all patients were supported by Rapid On-Site Evaluation(ROSE)during the EUS-FNA procedure,cytopathological evaluation of the tissue punctured by the first needle,and analysis of core tissue for other needle numbers quantity.The general conditions,the number of EUS-FNA puncture needles,and the pathological diagnosis results of the two groups of patients were analyzed and compared,and the diagnostic sensitivity,specificity,and prognosis of nCLE were analyzed.Further subgroup analysis was carried out according to the nature of the patients’ solid mass,and the positive rate of the first needle was evaluated for the patients whose solid mass was malignant.Results:A total of 63 patients were included in this study,and there was no significant difference between the study group and the control group in terms of gender,age,location of onset,and lesion size(P>0.05).There was no significant difference between the two groups in terms of puncture time(31.19±12.69 vs 29.11±11.16),puncture position,and whether the needle was changed during the puncture process(P>0.05);the number of puncture needles in the study group was less than that in the control group(2.56±1.15 vs 3.61±0.90),the difference was statistically significant(P<0.05);the area under the curve in the study group was AUC=0.909(0.767-1.00),the sensitivity was70.0%,and the specificity was 100%;the area under the curve in the control group was AUC=0.591(0.299-0.883),the sensitivity was 44.4%,and the specificity was 87.5%.There was 1 case of fever in the research group,and there was no significant difference between the two groups in the occurrence of adverse events,disease prognosis and outcome(P>0.05).For patients with solid malignant lesions,in the nCLE combined EUS-FNA study group,2 cases were positive and 2 case was negative,while in the control group,15 cases were positive and 12 cases were negative.Conclusion:For solid mass lesions such as the pancreas and mediastinum,nCLE has a certain guiding role,and the number of needles inserted in its combined EUS-FNA puncture is less than that in pure EUS-FNA puncture,and the positive rate of the first puncture is higher.