Moff Stephen L, Clark Douglas P, Maitra Anirban, Pandey Akhilesh, Thuluvath Paul J
Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
J Clin Gastroenterol. 2006 Apr;40(4):336-41. doi: 10.1097/01.mcg.0000210102.82241.de.
In patients with primary sclerosing cholangitis, there are no reliable markers or imaging modalities to detect malignant changes or early cholangiocarcinoma when curative interventions may still be possible.
Clinical features and outcomes were evaluated for 47 patients who underwent 101 endoscopic retrograde cholangiopancreatography (ERCP) procedures with bile duct brushings and cytopathologic examination for the detection of malignant changes between January 2001 and 2004. Bile duct cytology was characterized as unsatisfactory, benign, atypical, or malignant.
Fifteen patients had at least one sample that was abnormal. Patients with abnormal findings were older (P = 0.03); otherwise the groups were similar. Three of six patients with marked atypia have undergone transplantation for these abnormal findings, and of these, two had cholangiocarcinoma and one had no cancer detected in the explant. Of the nine patients with focal atypia, seven are doing well, one underwent transplantation for marked atypia seen on brushings at another hospital, and the other underwent transplantation for decompensated cirrhosis. Two patients with benign findings developed cholangiocarcinoma, whereas 29 others have not.
Cytopathologic examination of bile duct brushings taken at ERCP may be useful for the early detection of malignant changes in patients with primary sclerosing cholangitis. However, long-term prospective studies are needed to confirm the utility of surveillance ERCP and brushings.
在原发性硬化性胆管炎患者中，当仍有可能进行治愈性干预时，尚无可靠的标志物或影像学检查方法来检测恶性病变或早期胆管癌。
对2001年1月至2004年期间接受101次内镜逆行胰胆管造影（ERCP）检查并进行胆管刷检和细胞病理学检查以检测恶性病变的47例患者的临床特征和结局进行评估。胆管细胞学检查结果分为不满意、良性、非典型或恶性。
15例患者至少有一个样本异常。有异常发现的患者年龄较大（P = 0.03）；其他方面两组相似。6例有明显非典型病变的患者中有3例因这些异常发现接受了移植，其中2例患有胆管癌，1例移植切除标本中未发现癌症。9例有局灶性非典型病变的患者中，7例情况良好，1例因在另一家医院刷检时发现明显非典型病变而接受移植，另1例因失代偿性肝硬化接受移植。2例细胞学检查结果为良性的患者发生了胆管癌，而其他29例未发生。
ERCP检查时进行胆管刷检的细胞病理学检查可能有助于早期发现原发性硬化性胆管炎患者的恶性病变。然而，需要长期前瞻性研究来证实监测性ERCP和刷检的实用性。
