Objective To explore the value of pathologic diagnosis for pancreatic head mass by using recise Tru-cut biopsy under intraoperative ultrasound guided.
Methods Twenty-eight patients with solid pancreatic masses in People’s Hospital of Suqian，Affiliated Hospital Xuzhou Medical College from August 2010 to August 2011 were performed precise Tru-cut biopsy under intraoperative ultrasound guided. In all patients of 28 cases, male 20 cases and female 8 cases, the male-to-female ratio was 5∶2. The patients’ age was 34-78 years old（mean age： 64 years old）. Twenty-eight patients were divided into three groups based upon the greatest dimension of the masses as follows：equal or less than 1.5 cm （group S, 5 cases）, 1.5-3.0cm （group M, 7 cases）, and greater than 3.0cm （group L, 16 cases）. Three needle
passes in each mass were performed. The results of postoperative pathologic findings were compared with specimens in paraffin sections.
Results In all cases of 28, the diagnostic coincidence rate was 100%, there were no false positive finding and false negative. The coincidence ratio for pathological diagnosis of tissues with only 1 strip sample （1/3）, only 2 strip samples （2/3）, and with 3 strip samples （3/3） were 3/5, 2/5, and 0/0, respectivly in S group, 0/0, 5/7, and 2/7, respectivly in M group, and 0/0, 4/16, and 12/16, respectivly in L group. The false negative rate of single strip sample in S group and M group was higher than that in L group （χ2=9.833，P=0.002）. There was false negative finding with master single test in small focus of infection.
Conclusion Precise Tru-cut biopsy under intraoperative ultrasound guided is a safe and highly accurate method for pathological diagnosis of patients with solid pancreatic lesions, especially in small lesions，it is worthy of clinical application..
Citation：
CHEN Zheng,LIN Bin,SHI Xin,ZHAO Dongbo,SHI Xiaohong. Value of Intraoperative Ultrasound Guided Precise Tru-Cut Biopsy for Diagnosis of Solid Pancreatic Masses. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(7): 749-752. doi:
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- 1. Hartmann D， Schilling D， Bassler B， et al. ERCP and MRCP in the differentiation of pancreatic tumors [J]. Dig Dis， 2004，22(1)：18-25.
- 2. Farma JM， Santillan AA， Melis M， et al. PET/CT fusion scan enhances CT staging in patients with pancreatic neoplasms [J].Ann Surg Oncol， 2008， 15(9)：2465-2471.
- 3. Miura F， Takada T， Amano H， et al. Diagnosis of pancreatic cancer [J]. HPB (Oxford)， 2006， 8(5)：337-342.
- 4. Ihse I， Axelson J， Dawiskiba S， et al. Pancreatic biopsy：why? When? How? [J]. World J Surg， 1999， 23(9)：896-900.
- 5. 吴志勇， 罗蒙. 胰头肿块的治疗策略 [J]. 外科理论与实践，2009， 14(5)：494-496.
- 6. 邢雪， 欧琨， 边风国， 等. 胰头部位良性病变误诊八例 [J].中华普通外科杂志， 2004， 19(7)：446.
- 7. Schramm H， Urban H， Arnold F， et al. Intrasurgical pancreas cytology [J]. Pancreas， 2002， 24(2)：210-214.
- 8. Goldin SB， Bradner MW， Zervos EE， et al. Assessment of pancreatic neoplasms：review of biopsy techniques [J]. J Gastrointest Surg， 2007， 11(6)：783-790.
- 9. 杨秀疆， 谢渭芬， 任大宾， 等. 内镜超声引导细针穿刺对胰腺癌的诊断价值 [J]. 中华消化杂志， 2005， 25(8)：462-465.
- 10. Eloubeidi MA， Jhala D， Chhieng DC， et al. Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma [J]. Cancer， 2003， 99(5)：285-292.
- 11. Reddymasu S， Oropeza-Vail MM， Williamson S， et al. Pancreatic leak after endoscopic ultrasound guided fine needle aspiration managed by transpapillary pancreatic duct stenting [J]. JOP，2011， 12(5)：489-490.
- 12. Carrara S， Arcidiacono PG， Mezzi G， et al. Pancreatic endoscopic ultrasound-guided fine needle aspiration：complication rate and clinical course in a single centre [J]. Dig Liver Dis， 2010，42(7)：520-523.
- 13. Fernandez-Esparrach G， Gines A， Garcia P， et al. Incidence and clinical significance of hyperamylasemia after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions：a prospective and controlled study [J]. Endoscopy，2007， 39(8)：720-724.
- 14. 董家鸿， 黄志强. 精准肝切除——21 世纪肝脏外科新理念 [J]. 中华外科杂志， 2009， 47(21)：1601-1605.
- 15. 曹霖， 汪晓东， 李立. 多学科协作诊治模式的会诊流程探讨( 一) [J]. 中国普外基础与临床杂志， 2007， 14(3)：343-345.
- 16. 汪晓东， 曹霖， 李亚伦， 等. 多学科协作诊治模式的会诊流程探讨( 二) [J]. 中国普外基础与临床杂志， 2007， 14(5)：586-588.
- 17. Eloubeidi MA， Varadarajulu S， Desai S， et al. A prospective evaluation of an algorithm incorporating routine preoperative endoscopic ultrasound-guided fine needle aspiration in suspected pancreatic cancer [J]. J Gastrointest Surg， 2007， 11(7)： 813-819.
- 18. Yoshinaga S， Suzuki H， Oda I， et al. Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of solid pancreatic masses [J]. Dig Endosc， 2011， 23 Suppl 1：29-33.
- 19. Siddiqui AA， Brown LJ， Hong SK， et al. Relationship of pancreatic mass size and diagnostic yield of endoscopic ultrasoundguided fine needle aspiration [J]. Dig Dis Sci， 2011， 56(11)：3370-3375.
- 20. 庄岩， 杨尹默， 高红桥， 等. 胰头占位术中组织学穿刺活检的诊断效果与影响因素 [J]. 中华肝胆外科杂志， 2010， 16(5)：321-324.
- 21. 刘允怡， 赖俊雄. 胰头肿块的处理 [J]. 胰腺病学， 2006，6(1)：1-4.
- 22. 苗毅， 陈建敏. 胰头部肿块的病理学依据与手术决策 [J]. 中国实用外科杂志， 2009， 28(8)：637-639.
- 23. 中国普外基础与临床杂志编辑部. 多学科协作综合医疗模式—— MDT 的探讨 [J]. 中国普外基础与临床杂志， 2007，14(1)：31.
- 24. 王家祥， 郭立华. 临床疾病多学科协作综合治疗的思考 [J].医学与哲学( 人文社会医学版)， 2009， 30(7)：8-10.
- 25. Voss M， Hacmel P， Molas G， et al. Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses [J]. Gut， 2000， 46(2)：244-249.
- 26. Yun SS， Remotti H， Vazquez MF， et al. Endoscopic ultrasoundguided biopsies of pancreatic masses：comparison between fine needle aspirations and needle core biopsies [J]. Diagn Cytopathol，2007， 35(5)：276-282.
