陆军军医大学学报2026，Vol.48Issue(3)：337-344,8.DOI:10.16016/j.2097-0927.202510082
采用可调节光源改良宏观现场评估技术可显著提升EUS-FNA胰腺标本充足率与诊断准确率:一项随机交叉对照试验
Improved visualization with an adjustable-light modified macroscopic on-site evaluation technique enhances specimen adequacy and diagnostic accuracy in EUS-FNA for pancreatic lesions:A randomized crossover trial
摘要
Abstract
Objective Determine whether a modified macroscopic on-site evaluation(MOSE)technique,by enhancing visualization of the macroscopic visible core(MVC)in 22G/25G fine needle aspiration(FNA)specimens,improves specimen adequacy and pathological diagnostic accuracy.Methods This single-center,prospective,randomized crossover trial enrolled 90 consecutive patients with solid pancreatic lesions scheduled for EUS-FNA from the Department of Gastroenterology at the Third People's Hospital of Chengdu between February 2023 and August 2024.Patients were randomly assigned(1∶1)via a computer-generated sequence to Group A(first pass using traditional MOSE,second pass using modified MOSE)or Group B(first pass using modified MOSE,second pass using traditional MOSE).The core modification was the use of an adjustable white light source from 35 to 1 700 LUX at a fixed distance(37.2 mm)from the slide.Specimen adequacy was defined as MVC≥4 mm.The primary outcome was the specimen adequacy rate between groups.Secondary outcomes included the diagnostic accuracy of cytopathology and histopathology.Bias was controlled through blinded assessment(pathologists and data analysts were unaware of group allocation)and standardized operating procedures.Results The specimen adequacy rate was significantly higher in the modified MOSE group(70.0%,95%CI:59.9 to 78.5%)than in the traditional MOSE group(43.3%,95%CI:33.6 to 54.6%;χ²=13.714,P<0.001).The modified MOSE group also demonstrated superior diagnostic accuracy for both cytopathology[94.4%(95%CI:87.7%～97.6%)vs 85.6%(95%CI:76.8%～91.4%),χ2=4.9,P=0.021)and histopathology of tissue strips[95.6%(95%CI:89.1%～98.3%)vs 83.3%(95%CI:76.8%～91.4%),χ2=7.69,P=0.003].Subgroup analysis based on needle gauge demonstrated that for the 22G needle,which constituted 87.8%(79/90)of cases,the modified MOSE demonstrated statistically significant advantages over the traditional MOSE in the following outcomes:specimen adequacy rate[65.8%(95%CI:55.1%to 76.5%)vs 41.8%(95%CI:30.7%to 52.9%),P=0.003],cytological diagnostic accuracy[93.7%(95%CI:88.1%to 99.2%)vs 84.8%(95%CI:76.7%to 92.9%),P=0.039],and histological diagnostic accuracy[94.9%(95%CI:90.0%to 99.9%)vs 82.3%(95%CI:73.7%to 90.9%),P=0.013].Conclusion Modified MOSE can enhance the visualization of the MVC in specimens obtained by 22G/25G FNA,thereby improving the specimen adequacy rate and pathological diagnostic accuracy.关键词
超声内镜引导下细针穿刺抽吸术/胰腺肿瘤/现场评估Key words
endoscopic ultrasound-guided fine needle aspiration/pancreatic neoplasms/macroscopic on-site evaluation分类
医药卫生引用本文复制引用
周希,单晶,邓梦怡,罗丹,赵明,孙晓滨,姜琳..采用可调节光源改良宏观现场评估技术可显著提升EUS-FNA胰腺标本充足率与诊断准确率:一项随机交叉对照试验[J].陆军军医大学学报,2026,48(3):337-344,8.基金项目
成都市第三人民医院科研项目(2023PI21) （2023PI21）
成都市第三人民医院临床研究计划(CSY-YN-01-2023-049) Supported by the Research Project of the Third People's Hospital of Chengdu(2023PI21)and the Clinical Research Program of the Third People's Hospital of Chengdu(CSY-YN-01-2023-049). （CSY-YN-01-2023-049）
