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Z Gastroenterol 2008; 46(9): 897-908
DOI: 10.1055/s-2008-1027419
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Endosonografisch gestützte Biopsie: diagnostischer Ertrag, Fallstricke, Qualitätssicherung

Teil 2: Differenzialdiagnostische Möglichkeiten, Fallstricke und ProblemlösungenEndoscopic ultrasound-guided biopsy: diagnostic yield, pitfalls, quality managementPart 2: Opportunities of differential diagnosis, pitfalls, and problem solutionsC. Jenssen1 , K. Möller2 , S. Wagner3 , M. Sarbia4
  • 1Klinik für Innere Medizin, Krankenhaus Märkisch Oderland GmbH
  • 2Medizinische Klinik I – Gastroenterologie/Akutgeriatrie, Sana Klinikum Lichtenberg
  • 3Gemeinschaftspraxis für Pathologie, Königs Wusterhausen
  • 4Gemeinschaftspraxis Pathologie und Zytologie, München
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Publication History

Manuskript eingetroffen: 11.2.2008

Manuskript akzeptiert: 2.4.2008

Publication Date:
22 September 2008 (online)

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Zusammenfassung

Zahlreiche tumoröse Veränderungen beispielsweise von Pankreas, Leber, Nebenniere und gastrointestinaler Wandung sowie vergrößerte Lymphknoten sind differenzialdiagnostisch vieldeutig. Eine spezifische feingewebliche Diagnose ist Voraussetzung für differenzierte Therapieentscheidungen. Die endosonografische Biopsie ist entweder primär oder nach Versagen anderer Biopsietechniken ein sehr sicherer und effektiver Weg zur Materialgewinnung für zytologische und histologische Untersuchungen. Die Reproduzierbarkeit der zytopathologischen Diagnosen an endosonografisch gewonnenen Aspiraten ist für mit den Besonderheiten des Materials erfahrenen Zytopathologen sehr hoch. Falsch positive Malignitätsdiagnosen nach endosonografischer Feinnadelpunktion sind Raritäten, falsch negative kommen dagegen abhängig vom Zielgewebe, technischen Faktoren sowie der Erfahrung von Endosonografieteam und Zytopathologen in variabler Häufigkeit vor. Die differenzialdiagnostische Einordnung maligner und benigner Befunde ist im Regelfall möglich, allerdings bestehen zahlreiche Probleme und Fallstricke. Diese ergeben sich einerseits aus den Besonderheiten des bei der endosonografisch gestützten Biopsie gewonnenen Materials, andererseits aus der Vielfalt von möglichen Artdiagnosen, deren zytologische und histologische Merkmale sich teilweise überlappen oder stark ähneln können. In der vorliegenden Übersicht werden die artdiagnostischen Möglichkeiten an endosonografisch-feinnadelbioptisch gewonnenem Material, mögliche Fallstricke sowie Wege zur Minimierung der differenzialdiagnostischen Irrtumswahrscheinlichkeit diskutiert.

Abstract

The differential diagnosis of tumorous lesions in the pancreas, liver, adrenal gland or lymph nodes is ambiguous. Specific tissue diagnoses are essential for treatment decisions. Endoscopic ultrasound-guided biopsy has proven to be a reliable and effective modality in obtaining samples for cytological or histological examinations either primarily or in cases in which other biopsy techniques have failed. The reproducibility of cytopathological diagnoses among pathologists with special experience in assessing material obtained by endoscopic ultrasound-guided biopsies is very high. False positive diagnoses of malignancy in endoscopic ultrasound-guided biopsy are rare; false negative diagnoses appear in a variable frequency depending on target tissue, technical factors, and expertise of the endosonographer and cytopathologist. There are numerous challenges and pitfalls in the differential diagnostic classification of benign and malignant lesions. These problems are related to the characteristics of samples obtained by endoscopic ultrasound-guided biopsy, as well as to the multiple diagnoses with similar or overlapping cytological or histological characteristics. This review discusses the performance of endoscopic ultrasound-guided biopsy in establishing specific tissue diagnoses, possible pitfalls as well as opportunities to minimise differential diagnostic errors.

Schlüsselwörter

Endosonografie (EUS) - endosonografisch gestützte Feinnadelaspirationsbiopsie (EUS-FNA) - endosonografisch gestützte Trucut-Biopsie (EUS-TCB) - Qualität - Fallstricke - diagnostischer Irrtum

Key words

endoscopic ultrasound (EUS) - endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNA) - endoscopic ultrasound-guided trucut biopsy (EUS-TCB) - quality - pitfalls - diagnostic errors

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Dr. Christian Jenssen

Klinik für Innere Medizin, Krankenhaus Märkisch Oderland GmbH

Prötzeler Chaussee 5

15344 Strausberg

Phone: ++ 49/33 41/5 28 22

Email: c.jenssen@khmol.de