Objective: To investigate the combined application of cytology, cell block histology and immunohistochemistry to improve the diagnostic accuracy of solid pancreatic lesions in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples. Methods: The pathological data of EUS-FNA in 311 cases of solid pancreatic lesions submitted to the Second Hospital of Hebei Medical University, Shijiazhuang, China from May 2019 to September 2023 were retrospectively analyzed. The cases included pancreatic ductal adenocarcinoma (PDAC, 172 cases), solid pseudopapillary neoplasm (SPN, 12 cases), neuroendocrine tumors (PNET, 14 cases) and chronic pancreatitis (113 cases). The cytological features of smears, the histology of cell block sections and the diagnostic markers in PDAC, SPN and PNET were analyzed. The diagnostic accuracies of cytology, cell block histology/immunohistochemistry and combination of the two methods for classifying these pancreatic solid lesions were evaluated. Results: Irregular arrangement of atypical (cancer) cells, anisonucleosis and nuclear atypia were the typical cytological features of PDAC, while presence of pseudopapillae with a myxoid/hyalinized fibrovascular core and low adhesion/salt-and-pepper chromatin were diagnostic features of SPN and NET, respectively. Immunohistochemical results showed that CK7 and CK19 were the most sensitive markers of pancreatic ductal epithelia, and the diffuse strong expression of S-100P (102/111, 91.9%) and aberrant expression of p53 (80/111, 72.1%) were important immunophenotypic markers of PDAC. Various degrees of CDX2 expression could be found in 66.4% PDAC. The expression of CD10, PR, vimentin, CD99 and cyclinD1 and the aberrant expression of β-catenin were the immunophenotypic features of SPN, while the expression of CgA, Syn and CD56 were indispensable immunemarkers for the diagnosis of PNET. Overall, cytology had higher sensitivity than cell block histology (93.9% versus 82.8%) and lower specificity (92.9% versus 99.1%), while the combination of the two methods significantly improved the sensitivity to 96.9% in solid pancreatic lesions. The combination of cytology and cell block histology could significantly improve the diagnostic efficacy of EUS-FNA in PDAC. Conclusions: Integrated diagnosis based on cytology (including rapid on-site evaluation), cell block histology and immunohistochemical findings could significantly improve the diagnostic yield of EUS-FNA in classifying solid pancreatic lesions.
目的： 探讨联合应用细胞学、细胞块组织学及免疫组织化学方法提高胰腺实性病变内镜超声引导下细针穿刺（endoscopic ultrasound-guided fine-needle aspiration，EUS-FNA）诊断水平。 方法： 回顾性分析河北医科大学第二医院2019年5月至2023年9月311例胰腺实性病变EUS-FNA病理资料，研究胰腺导管腺癌（172例）、实性假乳头肿瘤（12例）、神经内分泌肿瘤（14例）和慢性胰腺炎（113例）EUS-FNA HE染色细胞学特征、细胞块组织学表现和免疫标志物在上述病变诊断、鉴别诊断中的价值，评价细胞学和细胞块组织学以及两种方法联合对胰腺实性占位性病变的诊断效能。 结果： 细胞排列不规则、细胞大小不一和核异型性是胰腺导管腺癌的典型细胞学特征，而围绕黏液样变/玻璃样变纤维血管轴的假乳头结构和低黏附性、染色质呈椒盐样则分别是实性假乳头肿瘤和神经内分泌肿瘤代表性细胞学特征。免疫组织化学显示细胞角蛋白（CK）7和CK19是灵敏的胰腺导管上皮标志物，S-100P蛋白弥漫强阳性表达（102/111，91.9%）和p53异常表达（80/111，72.1%）是胰腺导管腺癌重要的免疫表型特征，66.4%的胰腺导管腺癌还可见不同程度的CDX2阳性表达。而CD10、孕激素受体、波形蛋白、CD99和cyclin D1阳性表达及β-catenin异常表达是实性假乳头肿瘤具有诊断意义的免疫表型特征；嗜铬粒素A、突触素及CD56的阳性表达是神经内分泌肿瘤诊断的必要指标。本组胰腺实性病变EUS-FNA病理诊断中细胞学方法较细胞块组织学方法诊断灵敏度高（93.9%，82.8%）、特异度低（92.9%，99.1%），而两种方法联合能明显提高诊断灵敏度（96.9%）。细胞学与细胞块组织学结合可以明显提高胰腺导管腺癌EUS-FNA的诊断效能。 结论： 整合细胞学［包括快速现场评估（ROSE）］、细胞块组织学及免疫组织化学结果作出诊断可明显提高胰腺实性病变EUS-FNA诊断水平。.