Sheehan M M, Fraser A, Ravindran R, McAteer D
Department of Pathology, Aberdeen Royal Infirmary, Fosterhill, Aberdeen, UK.
Cytopathology. 2007 Aug;18(4):225-33. doi: 10.1111/j.1365-2303.2007.00447.x. Epub 2007 May 3.
Common bile duct (CBD) brushings have been recognized as a technique of moderate sensitivity and high specificity in identifying carcinoma of the ampulla and pancreatico-biliary regions. This study evaluated the increase in sensitivity of this technique using the ThinPrep technique of specimen preparation when compared with conventional cytology smears.
A total of 113 bile duct brushings were included in the study (38 conventional smears and 75 slides prepared using the ThinPrep technique). All slides were reviewed by one cytologist. Five categories of reporting were used: inadequate, negative, atypia, suspicious and malignant.
The inadequate category of reporting disappeared in the ThinPrep group with improved specimen fixation and preparation and hence reduced artefact. Sensitivity of diagnosis of malignancy increased from 39% in conventional smears to 53% in the ThinPrep group. Specificity, positive and negative predictive values and accuracy were 100%, 100%, 60% and 68% for conventional smears and were 100%, 100%, 60% and 72%, respectively, for ThinPrep specimens.
ThinPrep technique was associated with increased sensitivity of diagnosis, in part due to improved specimen fixation and reduced artefact. Cytology of bile duct brushings is an important diagnostic tool for sites from which it can be difficult to obtain a histology biopsy. It may therefore provide the only opportunity for tissue diagnosis of carcinoma from these sites, hence the importance of optimizing sensitivity.
胆总管刷检已被公认为是一种在识别壶腹癌和胰胆管区域癌方面具有中等敏感性和高特异性的技术。本研究评估了与传统细胞学涂片相比，使用ThinPrep标本制备技术时该技术敏感性的提高情况。
本研究共纳入113例胆管刷检样本（38例传统涂片和75例使用ThinPrep技术制备的玻片）。所有玻片均由一名细胞病理学家进行复查。采用五类报告方式：不满意、阴性、非典型、可疑和恶性。
ThinPrep组中不满意报告类别消失，标本固定和制备得到改善，因此伪像减少。恶性肿瘤诊断的敏感性从传统涂片的39%提高到ThinPrep组的53%。传统涂片的特异性、阳性和阴性预测值及准确性分别为100%、100%、60%和68%，ThinPrep标本分别为100%、100%、60%和72%。
ThinPrep技术与诊断敏感性的提高相关，部分原因是标本固定改善和伪像减少。胆管刷检细胞学是从难以获得组织学活检的部位进行诊断的重要工具。因此，它可能为这些部位的癌组织诊断提供唯一机会，所以优化敏感性很重要。
