在胆管狭窄方面，刷检细胞学优于通过一种新设备获取的活检。

Brush cytology is superior to biopsies obtained by a new device in bile duct strictures.

作者信息

Ung Kjell-Arne, Ljung Annika, Wågermark Jan, Lindholm Johan, Rydberg Lars, Kilander Anders, Stotzer P O, Burian Pawel

机构信息

Division of Gastroenterology, Department of Internal Medicine Kärnsjukhuset, University of Göteborg, SE-54185 Skövde, Sweden.

出版信息

Hepatogastroenterology. 2007 Apr-May;54(75):664-8.

PMID:17591037

Abstract

BACKGROUND/AIMS: Brush cytology during ERCP has been reported to have a low sensitivity. A new device, Howell biliary system (Wilson-Cook), enables targeted biopsies for histopathologic assessment. The aim was to compare histopathology with brush cytology.

METHODOLOGY

Brush cytology followed by biopsies obtained by the Howell device was taken consecutively from bile duct strictures. Coded slides were scored by 3 pathologists and 2 cytologists in a 3-graded scale; 2: benign; 3: suspicious of malignancy; 4: malignant. The clinical outcome including autopsy served as the gold standard for the definite diagnoses.

RESULTS

Twenty-one malignant and 6 benign strictures were evaluated. The histopathology revealed 11 out of the 21 malignant as certain or suspected malignant (score > or = 3) (sensitivity: 0.52). The cytology scored 17 out of 21 > or = 3 (sensitivity: 0.80). The in pair kappa values for the 3 pathologists were: (0.37; 0.26; 0.41) vs. 0.56 for the 2 cytologists. Among the evaluable strictures the pathologists scorings were; (median: 3.0, SD: 0.72) for the malignant and (median: 2.3, SD: 0.98) for the benign (p = 0.27) and the cytology scorings were; (median: 3.5, SD: 0.73) for the malignant and (median: 2.7, SD: 0.65) for the benign (p = 0.09).

CONCLUSIONS

Brush cytology has a higher accuracy than the targeted biopsies and should be used in combination with other methods to reach the correct diagnosis.

摘要

背景/目的：据报道，内镜逆行胰胆管造影术（ERCP）期间的刷检细胞学检查敏感性较低。一种新型设备——豪厄尔胆道系统（威尔逊-库克公司生产），可进行靶向活检以进行组织病理学评估。目的是比较组织病理学与刷检细胞学检查的结果。

方法

对胆管狭窄患者依次进行刷检细胞学检查，然后用豪厄尔设备进行活检。编码玻片由3名病理学家和2名细胞学家按照3级评分标准进行评分；2分：良性；3分：怀疑恶性；4分：恶性。包括尸检在内的临床结果作为明确诊断的金标准。

结果

对21处恶性狭窄和6处良性狭窄进行了评估。组织病理学检查显示，21处恶性狭窄中有11处确定或怀疑为恶性（评分≥3）（敏感性：0.52）。细胞学检查中，21处中有17处评分≥3（敏感性：0.80）。3名病理学家的配对kappa值分别为（0.37；0.26；0.41），而2名细胞学家的配对kappa值为0.56。在可评估的狭窄中，病理学家对恶性狭窄的评分是（中位数：3.0，标准差：0.72），对良性狭窄的评分是（中位数：2.3，标准差：0.98）（p = 0.27）；细胞学检查对恶性狭窄的评分是（中位数：3.5，标准差：0.73），对良性狭窄的评分是（中位数：2.7，标准差：0.65）（p = 0.09）。