mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/issn2072-3180.2020.4.27-33mossj-425Research ArticleАБДОМИНАЛЬНАЯ ХИРУРГИЯABDOMINAL SURGERYОЦЕНКА ЭФФЕКТИВНОСТИ ТОНКОИГОЛЬНОЙ АСПИРАЦИОННОЙ ПУНКЦИИ ОЧАГОВЫХ НОВООБРАЗОВАНИЙ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ ПОД ЭНДОСОНОГРАФИЧЕСКИМ НАВЕДЕНИЕМEVALUATION OF THE EFFECTIVENESS OF ENDOSONOGRAPHIC GUIDED FINE NEEDLE ASPIRATION PUNCTURE OF FOCAL LESIONS OF THE PANCREAShttps://orcid.org/0000-0002-0794-232XСолоницынЕ. Г.SolonitsynE. G.

Солоницын Евгений Геннадьевич — к.м.н., заведующий эндоскопическим отделением ФГБУ «НМИЦ им. В.А. Алмазова», доцент кафедры госпитальной хирургии СПбГУ

ул. Аккуратова, 2, Санкт-ПетербургУниверситетская наб., д. 7–9, Санкт-Петербург, 199034 

Solonitsyn Evgeny Gennadievich — PhD in Medicine, Department Head of endoscopy of Almazov National Medical Research Centre, associate Professor at the hospital surgery department, SPbU

7-9 University emb. 199034, St. Petersburg

sevgen@mail.ruКамаловаВ. Ф.KamalovaV. F.

Камалова Валерия Фанильевна — ординатор кафедры хирургических болезней

улица Аккуратова дом 2, г. Санкт-Петербург, 197341

Kamalova Valeria Fanil’evna — resident of surgical diseases department

2 Akkuratov street, 197341 St. Petersburg

lerakamalova.lk@gmail.comВанянА. В.VanianA. V.

Ванян Арсен Валериевич — ассистент кафедры госпитальной хирургии

Университетская наб., д. 7–9, Санкт-Петербург, 199034

Vanian Arsen Valerievich — assistant of hospital surgery department

7-9 University emb. 199034, St. Petersburg

https://orcid.org/0000-0002-4958-5850КащенкоВ. А.KashchenkoV. A.

Кащенко Виктор Анатольевич — профессор, д.м.н., заведующий кафедрой госпитальной хирургии

Университетская наб., д. 7–9, Санкт-Петербург, 199034

Kashchenko Viktor Anatol’evich — MD, professor, Head of the Department of hospital surgery

7-9 University emb. 199034, St. Petersburg

surg122@yandex.ruhttps://orcid.org/0000-0001-9540-7812ДаниловИ. Н.DanilovI. N.

Данилов Иван Николаевич — к.м.н., доцент кафедры хирургических болезней, заведующий отделением хирургических методов лечения онкологических больных

улица Аккуратова дом 2, г. Санкт-Петербург, 197341

Danilov Ivan Nikolaevich — PhD in Medicine, head of the Department of surgical methods of treatment of cancer patients

2 Akkuratov street, 197341 St. Petersburg

ivandanilov75@mail.ruhttps://orcid.org/0000-0002-7817-9069ВоробьевС. Л.VorobyovS. L.

Воробьев Сергей Леонидович — к.м.н., директор, врач-патологоанатом

ул. Олеко Дундича, д. 8, корп. 2, Санкт-Петербург, 192283

Vorobyev Sergey Leonidovich — PhD in Medicine, Director

lit. A, build. 2, 8 Oleko Dundicha St., Saint Petersburg 192283

slvorob@gmail.comhttps://orcid.org/0000-0001-8615-6273ШестопаловаТ. М.ShestopalovaT. M.

Шестопалова Татьяна Михайловна — врачпатологоанатом, врач клинической лабораторной диагностики

ул. Олеко Дундича, д. 8, корп. 2, Санкт-Петербург, 192283

Shestopalova Tatyana Mihajlovna — doctor pathologist

lit. A, build. 2, 8 Oleko Dundicha St., Saint Petersburg 192283

doctorcanis@yandex.ruhttps://orcid.org/0000-0003-4925-0126НеймаркА. Е.NeimarkA. E.

Неймарк Александр Евгеньевич — к.м.н.

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Neimark Aleksandr Evgen’evich — PhD in Medicine

2 Akkuratov street, 197341 St. Petersburg

sas_spb@mail.ruФГБУ «НМИЦ им. В.А. Алмазова»; СПбГУРоссияAlmazov National Medical Research Centre; St. Petersburg UniversityRussian FederationФГБУ «НМИЦ им. В.А. Алмазова»РоссияAlmazov National Medical Research CentreRussian FederationСПбГУРоссияSt. Petersburg UniversityRussian FederationНациональный центр клинической морфологической диагностикиРоссияNational center of clinical morphological diagnosticsRussian Federation202007032021042733Copyright © Солоницын Е.Г., Камалова В.Ф., Ванян А.В., Кащенко В.А., Данилов И.Н., Воробьев С.Л., Шестопалова Т.М., Неймарк А.Е., 20212021Солоницын Е.Г., Камалова В.Ф., Ванян А.В., Кащенко В.А., Данилов И.Н., Воробьев С.Л., Шестопалова Т.М., Неймарк А.Е.Solonitsyn E.G., Kamalova V.F., Vanian A.V., Kashchenko V.A., Danilov I.N., Vorobyov S.L., Shestopalova T.M., Neimark A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/425

Введение. В мире продолжает расти как заболеваемость, так и смертность от рака поджелудочной железы (ПЖ).Цель работы: Оценка эффективности эндосонографии с тонкоигольной аспирационной пункцией (ЭУС-ТАП) очаговых образований поджелудочной железы. Оценка влияния возраста, пола, размера образования, а также его локализации на информативность пункции.Материал и методы. В ретроспективное исследование вошло 244 пациента в период с 2012 по 2020 годы, которым была выполнена ЭУС-ТАП по поводу очаговых образований поджелудочной железы. Определялись факторы, влияющие на информативность, и проводилась их статистическая обработка.Результаты. У 244 пациентов было выполнено 454 морфологических исследования. Из них 211 цитологических, 149 гистологических и 94 иммуногистохимических (ИГХ). Частота информативных заключений оказалась выше в группе ИГХ по сравнению с цитологическим (p=1,611×10-6) и гистологическим исследованием (p=3,617×10-5). Информативность при пункции солидных образований была 75,5%, кистозно-солидных — 80,4%, а кистозных — 28,9%. (p=9,393×10-7). Информативность значительно снижается при выявлении ЭУС-признаков сопутствующего панкреатита (p=0,0026).Заключение. ЭУС-ТАП — эффективный и безопасный метод получения материала для морфологической диагностики. ЭУС-ТАП кистозных образований наименее информативна и связана с наибольшим количеством осложнений. Возраст, пол, размер образования, его локализация не оказывают влияния на информативность пункции. Сопутствующий хронический панкреатит достоверно снижает информативность ЭУС-ТАП.

Objective: to evaluate the effectiveness of endosonography guided fine needle aspiration (EUS-FNA) of focal lesions of the pancreas. Assessment of the impact of age, gender, size of the lesion and its localization on informativity of the puncture.Material and methods: the retrospective study included 244 patients between 2012 and 2020 who underwent EUS-FNA for pancreatic lesions. The factors influencing the information content were determined and their statistical processing was carried out.Results: 454 morphological studies were performed in 244 patients. Of these, 211 are cytological, 149 are histological, and 94 are immunohistochemical (IHC). The frequency of informative conclusions was higher in the IHC group compared to cytological (p=1.611×10-6) and histological studies (p=3.617×10-5). The information content in the puncture of solid formations was 75.5%, cystic-solid — 80.4%, and cystic — 28.9%. (p=9.393×10-7). Informativity is significantly reduced when EUS signs of background pancreatitis are detected (p=0.0026).Conclusion: EUS-FNA is an effective and safe method for obtaining material for morphological diagnostics. EUS-FNA of cystic formations is the least informative and is associated with the greatest cases of complications. Age, gender, size of the lesion, and its localization has no effect on informativity of the puncture. Background chronic pancreatitis significantly reduces the informativity of EUS-TAP. 

эндоскопическая ультрасонографиятонкоигольная аспирационная пункцияЭУС-ТАПочаговые образования поджелудочной железыэффективность ЭУС-ТАПendoscopic ultrasonographyEUS guided fine needle aspirationEUS-FNApancreatic focal lesionsEUS-FNA effectivenessReferencesBray F., Ferlay J., Soerjomataram I., Siegel R.L., Torre L.A., Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinician, 2018, Vol. 68, No. 6, pp. 394–424. https://doi.org/10.3322/caac.21492Bray F., Ferlay J., Soerjomataram I., Siegel R.L., Torre L.A., Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinician, 2018, Vol. 68, No. 6, pp. 394–424. https://doi.org/10.3322/caac.21492Rawla P., Sunkara, T., Gaduputi, V. Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors. World journal of oncology, 2019, Vol. 10, No. 1, pp. 10–27. https://doi.org/10.14740/wjon1166Rawla P., Sunkara, T., Gaduputi, V. Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors. World journal of oncology, 2019, Vol. 10, No. 1, pp. 10–27. https://doi.org/10.14740/wjon1166Polkowski M., Jenssen C., Kaye P., Carrara S., Deprez P., Gines A., Fernández-Esparrach G., Eisendrath P., Aithal G. P., Arcidiacono P., Barthet M., Bastos P., Fornelli A., Napoleon B., Iglesias-Garcia J., Seicean A., Larghi A., Hassan C., van Hooft J. E., Dumonceau J. M. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline – March 2017. Endoscopy, 2017, Vol. 49, No. 10, pp. 989–1006. https://doi.org/10.1055/s-0043-119219Polkowski M., Jenssen C., Kaye P., Carrara S., Deprez P., Gines A., Fernández-Esparrach G., Eisendrath P., Aithal G. P., Arcidiacono P., Barthet M., Bastos P., Fornelli A., Napoleon B., Iglesias-Garcia J., Seicean A., Larghi A., Hassan C., van Hooft J. E., Dumonceau J. M. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline – March 2017. Endoscopy, 2017, Vol. 49, No. 10, pp. 989–1006. https://doi.org/10.1055/s-0043-119219Catalano M. F., Sahai A., Levy M., Romagnuolo J., Wiersema M., Brugge W., Freeman M., Yamao K., Canto M., Hernandez L. V. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointestinal endoscopy, 2009, Vol. 69, No. 7, pp. 1251–1261. https://doi.org/10.1016/j.gie.2008.07.043Catalano M. F., Sahai A., Levy M., Romagnuolo J., Wiersema M., Brugge W., Freeman M., Yamao K., Canto M., Hernandez L. V. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointestinal endoscopy, 2009, Vol. 69, No. 7, pp. 1251–1261. https://doi.org/10.1016/j.gie.2008.07.043Iwashita T., Yasuda I., Shimizu M. Endoscopic ultrasound-guided tissue acquisition: Can fork and crown cut the tissue? Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society, 2019, Vol. 31, No. 2, pp. 146–147. https://doi.org/10.1111/den.13322Iwashita T., Yasuda I., Shimizu M. Endoscopic ultrasound-guided tissue acquisition: Can fork and crown cut the tissue? Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society, 2019, Vol. 31, No. 2, pp. 146–147. https://doi.org/10.1111/den.13322Mohamadnejad M., Mullady D., Early D. S., Collins B., Marshall C., Sams S., Yen R., Rizeq M., Romanas M., Nawaz S., Ulusarac O., Hollander T., Wilson R. H., Simon V.C., Kushnir V., Amateau S.K., Brauer B.C., Gaddam S., Azar R.R., Komanduri S., Wani S. Increasing Number of Passes Beyond 4 Does Not Increase Sensitivity of Detection of Pancreatic Malignancy by Endoscopic Ultrasound-Guided Fine-Needle Aspiration. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, 2017, Vol. 15, No. 7, pp. 1071–1078. https://doi.org/10.1016/j.cgh.2016.12.018Mohamadnejad M., Mullady D., Early D. S., Collins B., Marshall C., Sams S., Yen R., Rizeq M., Romanas M., Nawaz S., Ulusarac O., Hollander T., Wilson R. H., Simon V.C., Kushnir V., Amateau S.K., Brauer B.C., Gaddam S., Azar R.R., Komanduri S., Wani S. Increasing Number of Passes Beyond 4 Does Not Increase Sensitivity of Detection of Pancreatic Malignancy by Endoscopic Ultrasound-Guided Fine-Needle Aspiration. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, 2017, Vol. 15, No. 7, pp. 1071–1078. https://doi.org/10.1016/j.cgh.2016.12.018Iglesias-García J., Lariño-Noia J., Lindkvist B., Domínguez-Muñoz J.E. Endoscopic ultrasound in the diagnosis of chronic pancreatitis. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva, 2015, Vol. 107, No. 4, pp. 221–228.Iglesias-García J., Lariño-Noia J., Lindkvist B., Domínguez-Muñoz J.E. Endoscopic ultrasound in the diagnosis of chronic pancreatitis. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva, 2015, Vol. 107, No. 4, pp. 221–228.Perri G., Marchegiani G., Frigerio I., Dervenis C.G., Conlon K.C., Bassi C., Salvia R. Management of Pancreatic Cystic Lesions. Digestive surgery, 2020, Vol. 37, No. 1, pp. 1–9. https://doi.org/10.1159/000496509Perri G., Marchegiani G., Frigerio I., Dervenis C.G., Conlon K.C., Bassi C., Salvia R. Management of Pancreatic Cystic Lesions. Digestive surgery, 2020, Vol. 37, No. 1, pp. 1–9. https://doi.org/10.1159/000496509Iwashita T., Uemura S., Mita N., Iwasa Y., Ichikawa H., Senju A., Yasuda I., Shimizu M. Utility of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration for the diagnosis and management of pancreatic cystic lesions: Differences between the guidelines. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society, 2020, Vol. 32, No. 2, pp. 251–262. https://doi.org/10.1111/den.13579Iwashita T., Uemura S., Mita N., Iwasa Y., Ichikawa H., Senju A., Yasuda I., Shimizu M. Utility of endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration for the diagnosis and management of pancreatic cystic lesions: Differences between the guidelines. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society, 2020, Vol. 32, No. 2, pp. 251–262. https://doi.org/10.1111/den.13579Thosani N., Thosani S., Qiao W., Fleming J. B., Bhutani M. S., Guha S. Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions: a systematic review and meta-analysis. Digestive diseases and sciences, 2010, Vol. 55, No. 10, pp. 2756–2766. https://doi.org/10.1007/s10620-010-1361-8Thosani N., Thosani S., Qiao W., Fleming J. B., Bhutani M. S., Guha S. Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions: a systematic review and meta-analysis. Digestive diseases and sciences, 2010, Vol. 55, No. 10, pp. 2756–2766. https://doi.org/10.1007/s10620-010-1361-8ASGE Standards of Practice Committee, Muthusamy V.R. Chandrasekhara V., Acosta R.D., Bruining D.H., Chathadi K.V., Eloubeidi M.A., Faulx A.L., Fonkalsrud L., Gurudu S.R., Khashab M.A., Kothari S., Lightdale J.R., Pasha S.F., Saltzman J.R., Shaukat A., Wang A., Yang J., Cash B.D., DeWitt J.M. The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. Gastrointestinal endoscopy, 2016, Vol. 84, No. 1, pp. 1–9. https://doi.org/10.1016/j.gie.2016.04.014ASGE Standards of Practice Committee, Muthusamy V.R. Chandrasekhara V., Acosta R.D., Bruining D.H., Chathadi K.V., Eloubeidi M.A., Faulx A.L., Fonkalsrud L., Gurudu S.R., Khashab M.A., Kothari S., Lightdale J.R., Pasha S.F., Saltzman J.R., Shaukat A., Wang A., Yang J., Cash B.D., DeWitt J.M. The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. Gastrointestinal endoscopy, 2016, Vol. 84, No. 1, pp. 1–9. https://doi.org/10.1016/j.gie.2016.04.014Wang Q.X., Xiao J., Orange M., Zhang H., Zhu Y.Q. EUS-Guided FNA for Diagnosis of Pancreatic Cystic Lesions: a Meta-Analysis. Cellular physiology and biochemistry: international journal of experimental cellular physiology, biochemistry, and pharmacology, 2015, Vol. 36, No. 3, pp. 11971209. https://doi.org/10.1159/000430290Wang Q.X., Xiao J., Orange M., Zhang H., Zhu Y.Q. EUS-Guided FNA for Diagnosis of Pancreatic Cystic Lesions: a Meta-Analysis. Cellular physiology and biochemistry: international journal of experimental cellular physiology, biochemistry, and pharmacology, 2015, Vol. 36, No. 3, pp. 11971209. https://doi.org/10.1159/000430290Singhi A.D., Nikiforova M.N., Fasanella K.E., McGrath K.M., Pai R.K., Ohori N.P., Bartholow T.L., Brand R.E., Chennat J.S., Lu X., Papachristou G.I., Slivka A., Zeh H.J., Zureikat A.H., Lee K.K., Tsung A., Mantha G.S., Khalid A. Preoperative GNAS and KRAS testing in the diagnosis of pancreatic mucinous cysts. Clinical cancer research: an official journal of the American Association for Cancer Research, 2015, Vol. 20, No. 16, pp. 4381–4389. https://doi.org/10.1158/1078-0432.CCR-14-0513Singhi A.D., Nikiforova M.N., Fasanella K.E., McGrath K.M., Pai R.K., Ohori N.P., Bartholow T.L., Brand R.E., Chennat J.S., Lu X., Papachristou G.I., Slivka A., Zeh H.J., Zureikat A.H., Lee K.K., Tsung A., Mantha G.S., Khalid A. Preoperative GNAS and KRAS testing in the diagnosis of pancreatic mucinous cysts. Clinical cancer research: an official journal of the American Association for Cancer Research, 2015, Vol. 20, No. 16, pp. 4381–4389. https://doi.org/10.1158/1078-0432.CCR-14-0513Koshy A.K., Harshavardhan R.B., Siyad I., Venu R. P. Impact of calcifications on diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration for pancreatic ductal adenocarcinoma. Indian journal of gastroenterology: official journal of the Indian Society of Gastroenterology, 2019, Vol. 38, No. 2, pp. 128–133. https://doi.org/10.1007/s12664-019-00941-yKoshy A.K., Harshavardhan R.B., Siyad I., Venu R. P. Impact of calcifications on diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration for pancreatic ductal adenocarcinoma. Indian journal of gastroenterology: official journal of the Indian Society of Gastroenterology, 2019, Vol. 38, No. 2, pp. 128–133. https://doi.org/10.1007/s12664-019-00941-yVaradarajulu S., Tamhane A., Eloubeidi M. A. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointestinal endoscopy, 2005, Vol. 62, No. 5, pp. 728–753. https://doi.org/10.1016/j.gie.2005.06.051Varadarajulu S., Tamhane A., Eloubeidi M. A. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointestinal endoscopy, 2005, Vol. 62, No. 5, pp. 728–753. https://doi.org/10.1016/j.gie.2005.06.051

The authors declare that there are no conflicts of interest present.