Résumé
L’aspiration à l’aiguille fine (FNA) sous EED est une méthode diagnostique qui s’est développée rapidement ces derniéres années car elle apparaît à la fois efficace et bien adaptée pour déterminer la nature tumorale ou pseudo-tumorale de lésions pancréatiques, du foie gauche, de la voie biliaire principale, des surrénales, des parois digestives et du médiastin. L’examen cytologique bénéficiera d’une double technique associant l’étalement conventionnel sur lame et la cytologie en milieu liquide (LBC), selon Cytyc®. En effet, la technique de LBC est bien adaptée aux prélévements pauci-cellulaires rencontrés fréquemment lorsque l’on ponctionne des tumeurs fibreuses, nécrotiques ou kystiques. De même, elle facilite les techniques complémentaires, en particulier l’immunocytochimie. L’étude réalisée sous l’égide de la Société Française de Cytologie Clinique a montré un taux significativement plus bas d’échantillons non représentatifs et une plus grande sensibilité de la technique en LBC par rapport à la cytologie conventionnelle par étalement direct. La préparation d’un bloc cellulaire est une méthode de traitement histologique complémentaire améliorant les performances diagnostiques des FNA, permettant d’enrober dans un gel des micro-fragments tissulaires dispersés dans un caillot qui sont inclus en paraffine. Les coupes sériées seront complétées à la demande par des colorations spéciales et de l’immunohistochimie. Cette procédure est simple, facile à mettre en œuvre dans un laboratoire de pathologie. Le prélévement comme l’interprétation des lésions nécessitent de l’expérience. Dans le domaine des ponctions d’organes profonds, il faut insister sur l’importance de la collaboration entre le clinicien et le pathologiste.
Summary
EUS-fine needle aspiration (FNA) is a valuable, accurate and rapidly expanding diagnostic method, which can be applied to every tumor or tumorlike lesion of pancreas, left lobe of the liver, common bile duct, adrenal glands, gastrointestinal tract, and mediastinum. Combined conventional cytology and liquidbased cytology (LBC), particularly ThinPrep method are recommended. LBC is essential for paucicellular sampling such as fibrous, necrotic or cystic tumors and for ancillary techniques such as immunodetection. The French Society of Clinical Cytology study has demonstrated significantly lower rates of nonrepresentative samples and higher sensitivity for LBC than for conventional smears. A cell block preparation including tissue fragments and clotted blood in a gel matrix can routinely be used in every histopathology laboratory. This preparation is a complementary, histologic method of improving the diagnostic yield and accuracy of FNA, permitting multiple sections, special stains, and reliable immunohistochemichal techniques. Sampling and interpreting FNA require expertise. Close interaction between the clinician and the pathologist is an essential component of the success of FNA in the workup of deepseated lesions.
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Fabre, M. Comment réussir une ponction à l’aiguille fine sous échoendoscopie digestive?. Acta Endosc 35, 65–75 (2005). https://doi.org/10.1007/BF03002650
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DOI: https://doi.org/10.1007/BF03002650
Mots-clés
- aspiration à l’aiguille fine
- aspiration à l’aiguille fine sous échoendoscopie digestive
- cell block
- cytologie
- cytologie en milieu liquide
- diagnostic
- ThinPrep technique