Vandervoort J, Soetikno R M, Montes H, Lichtenstein D R, Van Dam J, Ruymann F W, Cibas E S, Carr-Locke D L
Divisions of Gastroenterology and Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Gastrointest Endosc. 1999 Mar;49(3 Pt 1):322-7. doi: 10.1016/s0016-5107(99)70008-8.
The accuracy and complication rates of brush cytology obtained from pancreaticobiliary strictures have not been fully defined. In this study we compared the accuracy and complications of brush cytology obtained from bile versus pancreatic ducts.
We identified 148 consecutive patients for whom brush cytology was done during an ERCP from a database with prospectively collected data. We compared cytology results with the final diagnosis as determined by surgical pathologic examination or long-term clinical follow-up. We followed all patients and recorded ERCP-related complications.
Forty-two pancreatic brush cytology samples and 101 biliary brush cytology samples were obtained. The accuracy rate of biliary cytology was 65 of 101 (64.3%) and the accuracy rate of pancreatic cytology was 30 of 42 (71.4%). Overall sensitivity was 50% for biliary cytology and 58.3% for pancreatic cytology. Of 67 patients with pancreatic adenocarcinoma, sensitivity for biliary cytology was 50% versus 66% for pancreatic cytology. Concurrent pancreatic and biliary cytology during the same procedure increased the sensitivity in only 1 of 10 (10%) patients. Pancreatitis occurred in 11 (11%) patients (9 mild cases, 2 moderate cases) after biliary cytology and in 9 (21%) patients (6 mild cases, 3 moderate cases) after pancreatic cytology (p = 0.22). In 10 patients who had pancreatic brush cytology, a pancreatic stent was placed. None of these patients developed pancreatitis versus 9 of 32 (28%) patients in whom a stent was not placed (p = 0.08). Pancreatic cytology samples obtained from the head of the pancreas were correct in 13 of 18 (72%) cases, from the genu in 7 of 7 (100%) cases, from the body in 5 of 9 (55%) cases, and from the tail in 4 of 7 (57%) cases.
The accuracy of biliary brush cytology is similar to the accuracy of pancreatic brush cytology. The yield of the latter for pancreatic adenocarcinoma is similar to that of the former. Complication rates for pancreatic cytology are not significantly higher than the rates for biliary cytology. The placement of a pancreatic stent after pancreatic brushing appears to reduce the risk of postprocedure pancreatitis.
从胰胆管狭窄处获取的刷检细胞学检查的准确性和并发症发生率尚未完全明确。在本研究中，我们比较了从胆管与胰管获取的刷检细胞学检查的准确性和并发症情况。
我们从一个前瞻性收集数据的数据库中，确定了148例在ERCP期间进行刷检细胞学检查的连续患者。我们将细胞学检查结果与通过手术病理检查或长期临床随访确定的最终诊断进行比较。我们对所有患者进行随访并记录与ERCP相关的并发症。
获取了42份胰腺刷检细胞学样本和101份胆管刷检细胞学样本。胆管细胞学检查的准确率为101例中的65例（64.3%），胰腺细胞学检查的准确率为42例中的30例（71.4%）。胆管细胞学检查的总体敏感性为50%，胰腺细胞学检查为58.3%。在67例胰腺腺癌患者中，胆管细胞学检查的敏感性为50%，而胰腺细胞学检查为66%。在同一操作过程中同时进行胰腺和胆管细胞学检查，仅10例患者中的1例（10%）敏感性有所提高。胆管细胞学检查后，11例（11%）患者发生胰腺炎（9例轻度，2例中度）；胰腺细胞学检查后，9例（21%）患者发生胰腺炎（6例轻度，3例中度）（p = 0.22）。在10例进行胰腺刷检细胞学检查的患者中放置了胰腺支架。这些患者均未发生胰腺炎，而未放置支架的32例患者中有9例（28%）发生胰腺炎（p = 0.08）。从胰腺头部获取的胰腺细胞学样本在18例中的13例（72%）中诊断正确，从胰腺膝部获取的样本在7例中的7例（100%）中诊断正确，从胰腺体部获取的样本在9例中的5例（55%）中诊断正确，从胰腺尾部获取的样本在7例中的4例（57%）中诊断正确。
胆管刷检细胞学检查的准确性与胰腺刷检细胞学检查相似。后者对胰腺腺癌的检出率与前者相似。胰腺细胞学检查的并发症发生率并不显著高于胆管细胞学检查。胰腺刷检后放置胰腺支架似乎可降低术后胰腺炎的风险。
