Journal Article 自己免疫性膵炎の診断におけるEUS-FNAの有用性に関する検討
Usefulness of EUS-guided fine needle aspiration in diagnosis of autoimmune pancreatitis

大坪, 公士郎  ,  毛利, 久継  ,  山下, 要  ,  安本, 和生  ,  井上, 大  ,  蒲田, 敏文  ,  池田, 博子  ,  渡邊, 弘之  ,  矢野, 聖二

32 ( 2 )  , pp.125 - 134 , 2015-11 , 日本消化器内視鏡学会甲信越支部・北陸支部 / 癌と化学療法社
ISSN:0912-0505
NCID:AN10525879
Description
We evaluated usefulness of EUS-guided fine needle aspiration (EUS-FNA) in the diagnosis of autoimmune pancreatitis (AIP). We retrospectively reviewed 21 patients in whom type 1 AIP was suspected and EUS-FNA was performed between January 2009 and June 2015. In EUS-FNA, more than 2 pathological findings characteristic of AIP (prominent infiltration and fibrosis of lymphocytes and plasmacytes, ten or more diffuse IgG4-positive plas-macytes per high-power microscopic field, storiform fibrosis, obliterative phlebitis) were recognized in 10 (77%) of 13 cases with lesions located in the pancreatic body and/or tail, although in only 2 (22%) of 9 cases with lesions located in the pancreatic head (one patient has the two lesions located in the pancreatic head, and body and tail). Diagnostic ability of EUS-FNA in AIP was satisfactory in cases with lesions located in the pancreatic body and tail, in which EUS-FNA with 19-gauge (19G) needle was easily performed. How to obtain sufficient materials for definite diagnosis of AIP may be the further problem in cases with lesions located in the pancreatic head, in which EUS-FNA with 19G needle is not easily performed. EUS findings, such as linear or reticular hyperechoic inclusions, duct penetrating sign, and peripancreatic hypoechoic margins, were observed in 15 (71%), 11 (52%), 12 (57%) of 21 cases, respectively. 自己免疫性膵炎 (autoimmune pancreatitis : AIP) における超音波内視鏡下穿刺吸引生検法 (EUS-guided fine needle aspiration : EUS-FNA) の有用性に関する検討を行った. 2009年1月~2015年6月まで1型AIPが疑われ, EUS-FNAを施行した21例を対象とした. EUS-FNAでは, 自己免疫性膵炎臨床診断基準2011における四つの病理所見のうち二つ以上認めた症例は, 21例中11例 (52%) であり, 19G穿刺針を使用しにくい頭部病変では9例中2例 (22%) のみであったが, 19G穿刺針を容易に使用できる体尾部病変では13例中10例 (77%) であった (1例では2領域を穿刺). AIPにおけるEUS-FNAの診断能は, 体尾部病変では良好であったが, 頭部病変では不十分であり, 頭部病変にて診断可能な検体量を確保することが今後の課題と考えられた. EUS所見では, linear or reticular hyperechoic inclusions, duct penetrating sign, peripancreatic hypoechoic marginsはそれぞれ15例 (71%), 11例 (52%), 12例 (57%) に認め, EUS像によるAIP補助診断に有用と思われた.
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http://dspace.lib.kanazawa-u.ac.jp/dspace/bitstream/2297/45948/1/HO-PR-OHTSUBO-K-125.pdf

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