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DOI: 10.1055/s-2003-40933
Endosonographisch gesteuerte transluminale Feinnadelpunktion
Untersuchung zur diagnostischen Qualität[1] Endosonographically controlled transluminal fine needle aspiration biopsyDiagnostic quality by cytologic and histopathologic classificationPublication History
eingereicht: 16.12.2002
akzeptiert: 22.2.2003
Publication Date:
28 July 2003 (online)
![](https://www.thieme-connect.de/media/dmw/200330/lookinside/thumbnails/10.1055-s-2003-40933-1.jpg)
Hintergrund und Fragestellung: Die Endosonographie (EUS) ermöglicht die hochauflösende Darstellung von Strukturen des Gastrointestinaltraktes und der paraintestinalen Organe, ferner besteht die Option der diagnostischen Feinnadelpunktion. Ziel dieser retro-spektiven Studie war es, die Qualität der endosonographisch gesteuerten transluminalen Feinnadelpunktion (EUS-FNA) zu evaluieren.
Patienten und Methodik: Unter Verwendung eines Endosonoskops PENTAX FG 32 UA (longitudinaler Sektorscan; 7,5 MHz) in Kombination mit einem Aspirationsnadelsystem Typ „Hancke-Vilmann” wurden 13 pankreatische, 9 adrenale, 6 abdominelle sowie 13 mediastinale Raumforderungen von 41 Patienten (56 ± 14 Jahre, m = 24, w = 17) endosonographisch feinnadelpunktiert und die pathologischen Präparate (n = 72) hinsichtlich Auswertbarkeit und Kontamination mit Fremdgewebe beurteilt.
Ergebnisse: Die Analyse von 34 Histologien und 38 Zytologien ergab 16 vs. 11 „sehr gut/gut”, 7 vs. 10 „ausreichend”, 7 vs. 13 „schlecht” und 4 vs. 4 „nicht” auswertbare Präparate. Die Kontamination mit Fremdgewebe war in 4 vs. 2 Präparaten „stark”, in 3 vs. 14 „deutlich”, in 8 vs. 19 „leicht” und in 19 vs. 3 Fällen „nicht” nachweisbar. Gut auswertbare Präparate waren signifikant weniger kontaminiert (p = 0,037). Benigne waren 35, maligne 24 Befunde. 13 Präparate waren unter dem Aspekt der Dignität nicht klassifizierbar. Bei 44 Feinnadelpunktionen bei 41 Patienten kam es in einem Fall zu einer asymptomatischen, selbstlimitierenden Einblutung im Zielgewebe. Die endosonographischen Organbioptate einschließlich die der Nebennieren waren in den meisten Fällen diagnostisch verwertbar (89 %). Die unzureichende diagnostische Aussagekraft einiger Präparate war mit einer Kontamination durch Fremdgewebe assoziiert.
Folgerung: Die EUS bereichert mit der endosonographischen Feinnadelpunktion die Diagnostik von außen schwer zugänglicher Organe und erweitert mit in der Mehrzahl verwertbarer Organbioptate die differentialdiagnostische Kompetenz insbesondere auch bei endokrinologischen Fragestellungen.
Background and objective: EUS-guided fine needle aspiration (EUS-FNA) has emerged as a highly accurate technique for detecting and classifying mediastinal and pancreatic lesions as well as abdominal and recently retroperitoneal masses with a minimum of risk for the patient.
Patients and Methods: To objectify these statements, we evaluated the quality of 72 EUS-FNA specimens by cytologic and histopathologic classification, investigated their contamination with tissue from the needle pathway and observed puncture-related complications in a retroperspective study of 44 EUS-FNA in 41 consecutive patients (56 ± 14 years, m = 24, f = 17; 13 pancreatic, 9 adrenal, 6 abdominal and 13 mediastinal masses). EUS-FNA was performed using a PENTAX 32 UA endosonoscope (longitudinal 7.5 MHz sector array) in combination with a needle system type „Hancke-Vilmann”.
Results: 16 vs. 11 of 34 histopathologic and 38 cytologic specimens were classified „excellent”, 7 vs. 10 „sufficient”, 7 vs. 13 „poor” and 4 vs. 4 „failed”. Analysis of contamination with tissue from the needle pathway showed 4 vs. 2 specimens „highly”, 3 vs. 14 „clearly”, 8 vs. 19 „slightly” and 19 vs. 3 „not” contaminated. Specimens classified „excellent” were less contaminated (p = 0,037). EUS-FNA identified 35 benign and 24 malignant masses. Definite diagnosis failed in 13 specimens. One nonfatal complication occurred. EUS-FNA is an accurate (89 %) and low-risk procedure to examine primary undiagnosed mediastinal, pancreatic, intraabdominal and especially adrenal lesions in most of the cases. Contamination with tissue from the needle pathway seems to be a major predictive factor of poor specimen quality and failed diagnosis.
Conclusion: EUS-FNA expands the diagnostic approach of mediastinal, abdominal, pancreatic and adrenal masses and provides accurate specimens for reaching new differential-diagnostic competence, especially in endocrinologic cases.
1 Fördermittel: Die Durchführung dieser Studie wurde von der Stiftung Rheinland-Pfalz für Innovation unterstützt.
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1 Fördermittel: Die Durchführung dieser Studie wurde von der Stiftung Rheinland-Pfalz für Innovation unterstützt.
Prof. Dr. med. Peter Herbert Kann
Leiter des Bereichs Endokrinologie & Diabetologie, Klinik
für Gastroenterologie, Stoffwechsel und Endokrinologie, Zentrum für
Innere Medizin, Klinikum der Philipps-Universität Marburg
Baldingerstraße
35033 Marburg
Phone: 06421/2863135
Fax: 06421/2862733
Email: kannp@med.uni-marburg.de