Acquire穿刺活检针和细针穿刺抽吸针用于超声内镜引导下1型自身免疫性胰腺炎穿刺诊断效能的比较研究

摘要/Abstract

摘要：

目的：比较22G-Acquire穿刺针穿刺活检（fine-needle biopsy，FNB）与22G-常规细针穿刺抽吸术（fine-needle aspiration，FNA）在1型自身免疫性胰腺炎（autoimmune pancreatitis，AIP）穿刺组织细胞学诊断中的应用价值。方法：回顾性纳入2020年1月至2024年1月期间我院收治的57例经影像学、血清学高度疑诊为1型AIP的患者。根据患者所用穿刺针型号，分为FNB针组（22G-Acquire针组）（n=30）和FNA针组（n=27），评价超声内镜（endoscopic ultrasonography，EUS）引导下2种穿刺针所获取的1型AIP组织学诊断等级。结果：在FNA组中，33.3%的穿刺组织存在淋巴浆细胞浸润，仅22.2%可见席纹状纤维化，组织学等级（Level）2证据等级占11.1%，而无Level 1证据。FNB组中63.3%穿刺组织存在淋巴浆细胞浸润，83.3%的穿刺组织可见席纹状纤维化，Level 1占比3.3%，Level 2占比56.7%，Level 1+2级共60%。2组中闭塞性静脉炎均未发现，IgG4阳性浆细胞>10个/高倍视野（high power field， HPF）共2例，FNB组及FNA组各1例。与FNA组相比，FNB组在所获组织中观察淋巴浆细胞浸润（63.3%比33.3%）（P=0.024）、席纹状纤维化（83.3%比22.2%）（P<0.001）均有较大优势，FNB组所获的证据等级更高（P<0.001）。结论：22G-Acquire针可获得更高的组织证据等级，可常规用于1型AIP的组织学诊断。

关键词:1型自身免疫性胰腺炎,细针穿刺活检,细针穿刺抽吸术,组织病理学诊断

Abstract:

Objective：To compare the application value of 22G-Acquire fine-needle biopsy (FNB) and conventional 22G fine-needle aspiration (FNA) in the cytological diagnosis of type 1 autoimmune pancreatitis (AIP).Methods：This retrospective study included 57 patients who were highly suspected of type 1 AIP based on imaging and serology and were admitted to our hospital from January 2020 to January 2024. According to the type of needle used, patients were divided into two groups: the FNB group (22G-Acquire needle,n=30) and the FNA group (n=27) to evaluate the histological diagnostic levels of type 1 AIP obtained by two needle types under endoscopic ultrasonography (EUS)-guided sampling.Results：In the FNA group, lymphoplasmacytic infiltration was observed in 33.3% of puncture tissues, while storiform fibrosis was identified in only 22.2%. Level 2 histological evidence was achieved in 11.1% of cases, with no Level 1 evidence. In the FNB group, lymphoplasmacytic infiltration was observed in 63.3% of puncture tissues, and storiform fibrosis was present in 83.3% of puncture tissues. Level 1 evidence was observed in 3.3% of cases, Level 2 in 56.7%, and combined Level 1+2 in 60%. Obliterative phlebitis was not detected in either group. Two cases met the criteria of IgG4-positive plasma cells >10 per high power field (HPF), with 1 case each in FNB group and FNA group. Compared to the FNA group, the FNB group showed significant advantages in the detection of lymphoplasmacytic infiltration (63.3%vs33.3%) (P=0.024) and storiform fibrosis (83.3%vs22.2%) (P<0.001) in the obtained tissues, along with higher evidence levels (P<0.001).Conclusion：The 22G-Acquire needle can obtain higher tissue evidence levels and can be routinely employed for the histological diagnosis of type 1 AIP.

Key words:Type 1 autoimmune pancreatitis,Fine-needle biopsy,Fine-needle aspiration,Histopathological diagnosis

中图分类号:

R446.8
R576

沈潇男, 周春华, 张本炎, 高丽丽, 张玲, 何相宜, 刘辰晓, 张贤达, 张尧, 吴巍, 龚婷婷, 张天宇, 刘磊, 邹多武, 张敏敏. Acquire穿刺活检针和细针穿刺抽吸针用于超声内镜引导下1型自身免疫性胰腺炎穿刺诊断效能的比较研究[J]. 诊断学理论与实践, 2025, 24(05): 498-504.

SHEN Xiaonan, ZHOU Chunhua, ZHANG Benyan, GAO Lili, ZHANG Ling, HE Xiangyi, LIU Chenxiao, ZHANG Xianda, ZHANG Yao, WU Wei, GONG Tingting, ZHANG Tianyu, LIU Lei, ZOU Duowu, ZHANG Minmin. Comparative study on diagnostic performance of Acquire fine-needle biopsy and fine-needle aspiration in endoscopic ultrasonography-guided tissue acquisition for type 1 autoimmune pancreatitis[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(05): 498-504.

图/表4

图1

表1

疑诊1型AIP患者的临床资料

Item	EUS-FNB （n=30）	EUS-FNA （n=27）	Pvalue
Age（year）	65.47±1.91	64.15±1.20	0.77
Gender			0.29
Male	25	25
Female	5	2
Serum IgG₄（g/L）	8.39±1.39	6.77±1.06	0.24
Location of pancreatic swelling
Diffuse	21	15
Focal	9	12
Stenosis of pancreatic duct（%）	20	26	0.59
Atrophy of pancreatic duct（%）	3.3	11.1	0.25
Puncture needle type			<0.001
22G-Acquire	30	0
22G-EXPECT	0	17
22G-EchoTip Ultra	0	10
Number of punctures	2.6	2.8	0.62

表1

Item	EUS-FNB	EUS-FNA	Pvalue
Lymphoplasmacytic infiltration(%)	63.3	33.3	0.024
Storiform fibrosis(%)	83.3	22.2	<0.001
Obstructive phlebitis(%)	0	0	/
IgG₄-positive plasma cells >10/HPF	3.3	3.7	0.94
Level 1(%)	3.3	0	<0.001
Level 2(%)	56.7	11.1	<0.001

表2

Item	EUS-FNB	EUS-FNA
Number of diagnosed AIP patients before puncture	21	15
Number of suspected AIP patients before puncture	9	12
Number of level 1 of suspected AIP patients	1	0
Number of level 2 of suspected AIP patients	4	1

表3

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