Logrono R, Kurtycz D F, Molina C P, Trivedi V A, Wong J Y, Block K P
Department of Pathology, University of Texas Medical Branch at Galveston, 77555-0548, USA.
Arch Pathol Lab Med. 2000 Mar;124(3):387-92. doi: 10.5858/2000-124-0387-AOFNDO.
Endoscopic brush cytology is a valuable technique for the diagnosis of pancreatobiliary malignancy. Despite its widespread use, the sensitivity of this method has been reported as approximately 50%. The specificity is usually higher than 95%. Few reports have systematically analyzed the reasons for this relatively low sensitivity.
To determine the rate and reasons for false-negative diagnoses in endoscopic brushing cytology of biliary and pancreatic ducts based on the results of sensitivity, specificity, accuracy, and positive and negative predictive values.
Retrospective analysis of laboratory data and slide review of false-negative cases.
Two tertiary care state university hospitals.
A total of 183 pancreatobiliary brushing specimens obtained from patients undergoing endoscopic retrograde cholangiopancreatography for biliary or pancreatic duct disease for a 4- to 5-year period.
Endoscopic retrograde cholangiopancreatography brushings.
Determination of sensitivity, specificity, accuracy, and positive and negative predictive values. Analysis of false-negative results.
The sensitivity, specificity, accuracy, and positive and negative predictive values, overall, were 48%, 98%, 79%, 92%, and 76%, respectively. Sampling error was a major cause of false-negative diagnoses (67%), followed by interpretive (17%) and technical errors (17%).
Improvements in sensitivity and diagnostic accuracy for cancer of the pancreatobiliary tract can be achieved by optimizing slide preparatory techniques. Also, enhancement of the cytologist's diagnostic skills enables the identification of the morphologic features of premalignant lesions. Repeat brushings are indicated for suspicious or negative results not consistent with the clinical or radiologic findings.
内镜刷检细胞学检查是诊断胰胆恶性肿瘤的一项重要技术。尽管该技术已被广泛应用，但其敏感性据报道约为50%。特异性通常高于95%。很少有报告系统分析导致这种相对较低敏感性的原因。
根据敏感性、特异性、准确性以及阳性和阴性预测值的结果，确定胆管和胰管内镜刷检细胞学检查假阴性诊断的发生率及原因。
对实验室数据进行回顾性分析，并对假阴性病例的玻片进行复查。
两家三级医疗的州立大学医院。
在4至5年期间，从因胆管或胰管疾病接受内镜逆行胰胆管造影术的患者中获取的183份胰胆刷检标本。
内镜逆行胰胆管造影刷检。
确定敏感性、特异性、准确性以及阳性和阴性预测值。分析假阴性结果。
总体而言，敏感性、特异性、准确性、阳性预测值和阴性预测值分别为48%、98%、79%、92%和76%。采样误差是假阴性诊断的主要原因（67%），其次是解释性误差（17%）和技术误差（17%）。
通过优化玻片制备技术，可以提高胰胆管癌的敏感性和诊断准确性。此外，提高细胞病理学家的诊断技能有助于识别癌前病变的形态学特征。对于与临床或影像学结果不一致的可疑或阴性结果，建议重复刷检。
