Furmanczyk Paul S, Grieco Verena S, Agoff S Nicholas
University of Washington, School of Medicine, Seattle, WA 98111, USA.
Am J Clin Pathol. 2005 Sep;124(3):355-60. doi: 10.1309/J030-JYPW-KQTH-CLNJ.
Interpreting biliary brush cytology (BBC) findings in primary sclerosing cholangitis (PSC) is problematic. In our study, BBC findings and CA19-9 serum levels were evaluated for their effectiveness in diagnosing cholangiocarcinoma in patients with PSC. We reviewed 107 biliary brushings from 51 patients with PSC and concurrent CA19-9 levels between January 1995 and March 2004 at the University of Washington Medical Center, Seattle. A portion of the brushings were evaluated and scored according to specific cytologic criteria; statistical analysis showed which criteria were most predictive in diagnosing malignancy: nuclear/cytoplasmic ratio, prominent nucleoli, nuclear membrane irregularities, and discohesion were significant predictive features. Sensitivity and specificity of BBC were 62.5% and 100%, respectively. Sensitivity and specificity of CA19-9 at a cutoff of 186 IU/mL were 100% and 94%, respectively. BBC is a specific and relatively sensitive method of detecting cholangiocarcinoma, even in patients with PSC, especially when certain cytomorphologic features are identified. Combining biliary cytology and CA19-9 levels might have an important diagnostic role in PSC.
解读原发性硬化性胆管炎（PSC）患者的胆管刷检细胞学（BBC）结果存在问题。在我们的研究中，评估了BBC结果和CA19-9血清水平在诊断PSC患者胆管癌方面的有效性。我们回顾了1995年1月至2004年3月在西雅图华盛顿大学医学中心的51例PSC患者的107次胆管刷检及同期的CA19-9水平。根据特定的细胞学标准对部分刷检样本进行评估和评分；统计分析显示哪些标准在诊断恶性肿瘤方面最具预测性：核质比、明显核仁、核膜不规则及细胞解离是显著的预测特征。BBC的敏感性和特异性分别为62.5%和100%。CA19-9在临界值为186 IU/mL时的敏感性和特异性分别为100%和94%。BBC是检测胆管癌的一种特异性且相对敏感的方法，即使在PSC患者中也是如此，尤其是当识别出某些细胞形态学特征时。结合胆管细胞学检查和CA19-9水平可能在PSC的诊断中发挥重要作用。
