Endosonografisch gestützte Biopsie: diagnostischer Ertrag, Fallstricke, Qualitätssicherung

Zusammenfassung

Endosonografische Biopsien haben sich zur Diagnosesicherung von benignen und malignen Erkrankungen sowie zum Staging von malignen Tumoren des Verdauungstraktes und der angrenzenden Organe bewährt. Die oft erhebliche prognostische und therapeutische Relevanz dieser Befunde stellt Endosonografiker und Zytopathologen in eine große gemeinsame Verantwortung und macht qualitätssichernde Maßnahmen erforderlich. Die diagnostische Ausbeute endosonografischer Biopsien ist abhängig von der Lokalisation, Größe und Beschaffenheit des Zielgewebes, technischen Faktoren wie der eingesetzten Nadel, der Biopsietechnik und der Materialverarbeitung, aber auch von Training und Erfahrung des Endosonografikers und des Zytopathologen sowie von deren Interaktion. Die On-site-Zytologie ist ein insbesondere an akademischen Zentren der USA und Frankreichs erfolgreicher Weg zur Optimierung der diagnostischen Effizienz der endosonografischen Feinnadelaspirationsbiopsie. Unter den ökonomischen und strukturellen Bedingungen des deutschen Gesundheitssystems erscheint es als eine sinnvolle Alternative, zusätzlich zu zytologischen Ausstrichen primär die Gewinnung histologisch und immunhistochemisch untersuchbaren Materials anzustreben. Dies gelingt durch endosonografische Feinnadelaspirationsbiopsie mit 22-Gauge-Nadeln in 3 von 4 Fällen. In Einzelfällen kann der Einsatz von 19-Gauge-Aspirations- oder Trucut-Nadeln erforderlich werden.

Abstract

Endoscopic ultrasound-guided biopsies have proven to be of significant value in the diagnostic evaluation of benign and malignant diseases, as well as in the staging of malignant tumours of the gastrointestinal tract and adjacent organs. The high prognostic and therapeutic relevance of the resulting cytopathological diagnoses necessitates a shared responsibility of endosonographer and cytopathologist. Quality control programs are required. The diagnostic yield of endoscopic ultrasound-guided biopsies depends on the location, size and characteristics of target tissues, and technical factors (i. e., type of needle used, biopsy technique, and material processing). Other weighing factors include training, expertise and interaction of the endosonographer with cytopathologists. On-site cytological evaluation, which has proven to be successful in optimising the diagnostic efficiency of endoscopic ultrasound-guided fine-needle aspiration biopsy, is notably practiced in Northern American and French academic institutions. It seems to be a sensible alternative to collect specimens for histological and immunohistochemical investigations in addition to the cytological smears in consideration of the economic and structural terms in the German health-care system. Endoscopic ultrasound-guided fine-needle aspiration succeeds in harvesting core biopsies in 3 out of 4 cases with 22-gauge needles. Therefore the use of 19-gauge needles for endoscopic ultrasound-guided aspiration or trucut biopsy may be necessary only in selected cases.

Schlüsselwörter

Endosonografie (EUS) - endosonografisch gestützte Feinnadelaspirationsbiopsie (EUS-FNA) - endosonografisch gestützte Trucut-Biopsie (EUS-TCB) - On-site-Zytologie - Training - Qualitätssicherung

Key words

endoscopic ultrasound (EUS) - endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNA) - endoscopic ultrasound-guided trucut biopsy (EUS-TCB) - on-site cytology - training - quality assurance

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