Solid pancreatic lesions: etiology, morphology and utility of macroscopic on-site evaluation in predicting good yield of endoscopic ultrasound-guided biopsy.

IF 2.5 Q3 GASTROENTEROLOGY & HEPATOLOGY
Przegla̜d Gastroenterologiczny Pub Date : 2025-01-01 Epub Date: 2025-06-06 DOI:10.5114/pg.2025.151850
Abbas Ali Tasneem, Taha Yaseen, Syed Mudassir Laeeq, Zain Majid, Nasir Hassan Luck
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引用次数: 0

Abstract

Introduction: Solid pancreatic lesions (SPL)s can be due to various etiologies, and their management depends on the histologic diagnosis.

Aim: The aim of this study was to document the etiology, morphology, and utility of macroscopic on-site evaluation (MOSE) in predicting good yield of endoscopic ultrasound (EUS)-guided biopsy.

Material and methods: All patients with SPLs referred for EUS-guided biopsy were included in the study. Etiology, morphology and results of EUS-guided biopsy were recorded. Rapid on-site evaluation (ROSE) was not available; therefore, MOSE was performed by an endoscopist. Macroscopically, MOSE was considered satisfactory if at least 1 tissue core at least 1 inch long was secured. Histopathologically, a biopsy specimen was considered to have a good yield if it was sufficient to establish a diagnosis. Factors predicting good yield of biopsy (GYB) were identified.

Results: Of the total 176 patients included in the study, 111 (63.1%) were male (mean age 53.8 (±12.6) years; range: 14-80 years). Good yield biopsies (GYB) numbered 144 (81.8%); among them, 97 (67.4%) were neoplastic and 47 (32.6%) non-neoplastic SPLs. The commonest neoplastic SPLs were pancreatic ductal adenocarcinoma (PDA) (76; 78.3%), neuroendocrine tumors (NETs) (13; 13.4%), metastasis (5; 5.1%), and others (3; 3.1%), while the commonest non-neoplastic SPLs were mass-forming chronic pancreatitis (MFCP) (33; 70.2%), autoimmune pancreatitis (AIP) (5; 10.6%), and tuberculosis (2; 4.3%). PDAs were more common in older patients (65/76; 85.5%) and in the head region of the pancreas (47; 61.8%), while NETs were more common in younger patients 7/13 (53.8%) and in the body of the pancreas 5/13 (38.5%). Factors predicting GYB were SPL size > 15 mm (p = 0.045), use of fine needle biopsy (FNB) needles (p = 0.001), ≥ 2 passes (p = 0.001), and satisfactory MOSE (p ≤ 0.0001) on univariate analysis; and FNB use (p = 0.049) and satisfactory MOSE (p = 0.001) on multivariate analysis. Our criteria for satisfactory MOSE had high sensitivity (85.4%), positive predictive value (95.35%), and diagnostic accuracy (84.7%).

Conclusions: The commonest neoplastic SPLs are PDA and NET, and the commonest non-neoplastic SPLs are MFCP and AIP. PDAs have a predilection for the head region and older age, while NETs have a predilection for younger patients and the body of the pancreas. A good biopsy yield is likely with use of FNB needles and satisfactory MOSE.

胰腺实性病变:病因学、形态学和预测超声内镜引导下活检良率的宏观现场评估的应用。
实性胰腺病变(SPL)可由多种病因引起,其治疗取决于组织学诊断。目的:本研究的目的是记录病因、形态学和宏观现场评估(MOSE)在预测内镜超声(EUS)引导下活检的良好产量方面的应用。材料和方法:所有经eus引导活检的spl患者均纳入研究。记录病因、形态学和eus引导下活检结果。没有快速现场评价(ROSE);因此,MOSE由内窥镜医师进行。宏观上,如果至少有1个至少1英寸长的组织核被固定,MOSE被认为是满意的。组织病理学上,活检标本被认为有良好的产量,如果它足以建立诊断。确定了预测良好活检率(GYB)的因素。结果:纳入研究的176例患者中,男性111例(63.1%),平均年龄53.8(±12.6)岁;范围:14-80年)。良率活检(GYB) 144例(81.8%);其中97例(67.4%)为肿瘤性,47例(32.6%)为非肿瘤性。最常见的肿瘤性胰腺导管腺癌(PDA)(76例;78.3%),神经内分泌肿瘤(NETs) (13;13.4%),转移(5;5.1%),其他(3;3.1%),而最常见的非肿瘤性SPLs是形成团块的慢性胰腺炎(MFCP) (33;70.2%),自身免疫性胰腺炎(AIP) (5%;10.6%)和结核病(2%;4.3%)。pda在老年患者中更为常见(65/76;85.5%)和胰头区(47;net多见于年轻患者(7/13)(53.8%)和胰腺体(5/13)(38.5%)。单因素分析预测GYB的因素为SPL大小bb0 ~ 15mm (p = 0.045)、使用细针活检针(FNB) (p = 0.001)、≥2次通过(p = 0.001)和满意的MOSE (p≤0.0001);和FNB使用(p = 0.049)和满意的MOSE (p = 0.001)。我们的MOSE满意标准具有高灵敏度(85.4%)、阳性预测值(95.35%)和诊断准确率(84.7%)。结论:最常见的肿瘤性SPLs是PDA和NET,最常见的非肿瘤性SPLs是MFCP和AIP。pda倾向于头部区域和老年人,而NETs倾向于年轻患者和胰腺体。使用FNB针和满意的MOSE有可能获得良好的活检率。
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来源期刊
Przegla̜d Gastroenterologiczny
Przegla̜d Gastroenterologiczny GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
2.20
自引率
7.70%
发文量
50
审稿时长
6-12 weeks
期刊介绍: Gastroenterology Review is a journal published each 2 months, aimed at gastroenterologists and general practitioners. Published under the patronage of Consultant in Gastroenterology and Polish Pancreatic Club.
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