Adamsen Sven, Olsen Marianne, Jendresen Marianne Bille, Holck Susanne, Glenthøj A
Department of Gastrointestinal Surgery, Copenhagen University Hospital Herlev, Denmark.
Scand J Gastroenterol. 2006 May;41(5):597-603. doi: 10.1080/00365520500389099.
Obtaining cytological specimens by wire-guided endobiliary brushing at the time of endoscopic retrograde cholangiopancreatography (ERCP) is a convenient way to reach a diagnosis. Sensitivity for malignant disease is generally around 50% and specificity around 100%. The present study was designed to assess the reproducibility of the cytological examination.
Samples were obtained from 55 consecutive patients with biliary duct strictures that eventually turned out to be caused by malignant disease in 41 patients (73%). The cytology specimens were evaluated twice in different random order with an interval of at least 4 months by two pathologists blinded to the final diagnoses. Suitability for diagnosis (suitable, suboptimal or unsuitable) and cytologic diagnosis (benign, atypical, suspicious for malignancy and malignant cells) were registered. Kappa analysis was applied.
Regarding suitability for diagnosis, the two observers reproduced their findings in 84% (kappa 0.76) and 87% (0.59) (p>0.05), while the interobserver variations on the two occasions were 76% and 78% (kappa 0.49 and 0.58, respectively) (p>0.05). Five percent of samples were rated as inadequate for diagnosis in at least one reading; 18% were suboptimal and 62-82% were suitable. The observers reproduced their cytological diagnosis in 77% and 71% (weighted kappa 0.83 and 0.75) (p>0.05), and agreed on the cytological diagnosis in 65% and 73% (weighted kappa 0.65 and 0.75) (p>0.05).
The intra- and interobserver agreement in cytological evaluation of endobiliary brushings from bile duct strictures is generally good. The rates of inadequate and suboptimal samples can probably be reduced by modifications of the brush design.
在进行内镜逆行胰胆管造影术（ERCP）时，通过金属丝引导的胆管刷检获取细胞学标本是一种方便的诊断方法。恶性疾病的敏感性一般约为50%，特异性约为100%。本研究旨在评估细胞学检查的可重复性。
从55例连续性胆管狭窄患者中获取样本，最终发现41例（73%）患者的胆管狭窄由恶性疾病引起。细胞学标本由两名对最终诊断不知情的病理学家以不同的随机顺序进行两次评估，间隔至少4个月。记录诊断的适宜性（适宜、次优或不适宜）和细胞学诊断（良性、非典型、可疑恶性和恶性细胞）。应用kappa分析。
关于诊断的适宜性，两位观察者在84%（kappa 0.76）和87%（0.59）的情况下重现了他们的发现（p>0.05），而两次观察之间观察者间的差异分别为76%和78%（kappa分别为0.49和0.58）（p>0.05）。5%的样本在至少一次读数中被评为诊断不足；18%为次优，62 - 82%为适宜。观察者在77%和71%的情况下重现了他们的细胞学诊断（加权kappa 0.83和0.75）（p>0.05），在65%和73%的情况下对细胞学诊断达成一致（加权kappa 0.65和0.75）（p>0.05）。
胆管狭窄的胆管刷检细胞学评估中，观察者内和观察者间的一致性总体良好。通过改进刷检设计可能降低诊断不足和次优样本的比例。
