Kurzawinski T, Deery A, Dooley J, Dick R, Hobbs K, Davidson B
Hepatobiliary and Liver Transplantation Unit, Royal Free Hospital and School of Medicine, London.
Gut. 1992 Dec;33(12):1675-7. doi: 10.1136/gut.33.12.1675.
Imaging of biliary strictures may suggest malignancy but cytology can provide a tissue diagnosis. The aim of this study is to compare the diagnostic value of brush cytology and bile cytology. Thirty two patients (20 males, 12 females, median age 66 years, range 31-84) with biliary strictures at endoscopic retrograde cholangio pancreatography (24) or percutaneous transhepatic cholangiography (8) had bile cytology and brush cytology. Brushings were taken using a modified Geenan cytology brush (6 Fr gauge, Wilson Cook) passed alongside a guide wire placed through the stricture. Bile was aspirated after insertion of an internal/external catheter or an endoprosthesis. Bile and brushings were examined by one experienced cytologist (AD) and was reported as positive or negative for malignant cells. Twenty nine patients had malignant strictures. Sixteen were confirmed by histology and 13 had malignancy suggested by clinical follow up. Three patients had resection of histologically benign strictures. The overall sensitivity of brush cytology (17 of 29 positive, 59%) was significantly greater than bile cytology (seven of 29 positive, 24%) (p < 0.01) as was the diagnostic accuracy (63 v 31%, p < 0.01). None of the patients had positive bile cytology with negative brush cytology. There were no procedure related complications and the average sampling time once the guide wire had been inserted was less than five minutes. It is concluded that brush cytology is more sensitive than bile cytology and with the technique described is safe and rapid.
胆管狭窄的影像学检查可能提示恶性病变，但细胞学检查可提供组织学诊断。本研究的目的是比较刷检细胞学和胆汁细胞学的诊断价值。32例胆管狭窄患者（20例男性，12例女性，中位年龄66岁，范围31 - 84岁）在内镜逆行胰胆管造影（24例）或经皮肝穿刺胆管造影（8例）时接受了胆汁细胞学和刷检细胞学检查。使用改良的吉南细胞学刷（6F规格，威尔逊·库克公司）沿通过狭窄部位置入的导丝进行刷检。在插入内外引流管或内支架后抽吸胆汁。胆汁和刷检样本由一名经验丰富的细胞学家（AD）检查，并报告是否存在恶性细胞。29例患者为恶性狭窄。16例经组织学证实，13例经临床随访提示为恶性。3例患者切除了组织学上为良性的狭窄病变。刷检细胞学的总体敏感性（29例中有17例阳性，59%）显著高于胆汁细胞学（29例中有7例阳性，24%）（p < 0.01），诊断准确性也是如此（分别为63%和31%，p < 0.01）。没有患者胆汁细胞学阳性而刷检细胞学阴性。没有与操作相关的并发症，插入导丝后的平均采样时间少于5分钟。结论是刷检细胞学比胆汁细胞学更敏感，并且所描述的技术安全、快速。
