Uchida Naohito, Kamada Hideki, Tsutsui Kunihiko, Ono Masahiro, Aritomo Yuichi, Masaki Tsutomu, Kushida Yoshio, Haba Reiji, Nakatsu Toshiaki, Kuriyama Shigeki
Department of Gastroenterology and Neurology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun 761-0793, Japan.
J Gastroenterol. 2007 Aug;42(8):657-62. doi: 10.1007/s00535-007-2071-7. Epub 2007 Aug 24.
The aim of this study was to evaluate the usefulness of pancreatic duct brushing for diagnosis of pancreatic carcinoma.
Brush cytology was attempted in 58 patients suspected of having pancreatic malignancy because of stricture of the main pancreatic duct, confirmed by endoscopic retrograde cholangiopancreatography. Thirty-eight patients were finally diagnosed by an operation or the clinical course as having pancreatic carcinoma, and the remaining 20 patients as having chronic pancreatitis. The usefulness of brush cytology for diagnosis of pancreatic carcinoma was estimated. We interpreted failures of pancreatic duct brushing to be false negatives when the lesion was malignant.
In 48 of 58 patients (82.8%), brushing was successfully performed and satisfactory specimens were obtained. Brush cytology was positive in 25 of 38 patients with pancreatic carcinoma (sensitivity 65.8%) and negative in all patients without malignancy (specificity 100%). Overall accuracy was 76.4%. During 2001-2005, the number of back-and-forth motions of the brush was increased to more than 30 times. The sensitivity significantly improved from 43.8% in 1997-2000 to 81.8% in 2001-2005 (P < 0.05). The increased success rate of brushing by improvement of skill in manipulating the guidewire and increased number of cells smeared on glass slides by increased back-and-forth motion of the brush may account for this improvement over time. Moreover, the sensitivity in 2001-2005 was 85.7% if failures of brushing with pancreatic carcinoma are excluded. No major complications occurred, except for two patients with a moderate grade of acute pancreatitis.
Although further studies with a large number of patients are needed, our results suggest that with recent improvements of the brushing technique, pancreatic duct brushing is a useful and safe method for the differential diagnosis of malignancy from benign diseases of the pancreas.
本研究的目的是评估胰管刷检对胰腺癌诊断的实用性。
对58例因主胰管狭窄而疑似患有胰腺恶性肿瘤的患者进行刷检细胞学检查，主胰管狭窄经内镜逆行胰胆管造影证实。最终38例患者经手术或临床病程诊断为胰腺癌，其余20例患者诊断为慢性胰腺炎。评估刷检细胞学对胰腺癌诊断的实用性。当病变为恶性时，我们将胰管刷检失败解释为假阴性。
58例患者中有48例（82.8%）成功进行了刷检并获得了满意的标本。38例胰腺癌患者中25例刷检细胞学呈阳性（敏感性65.8%），所有无恶性肿瘤的患者刷检细胞学均为阴性（特异性100%）。总体准确率为76.4%。在2001 - 2005年期间，刷检时刷子的来回移动次数增加到30次以上。敏感性从1997 - 2000年的43.8%显著提高到2001 - 2005年的81.8%（P < 0.05）。随着时间的推移，通过提高导丝操作技巧提高了刷检成功率，以及通过增加刷子的来回移动次数增加了涂在载玻片上的细胞数量，可能是这种改善的原因。此外，如果排除胰腺癌刷检失败的情况，2001 - 2005年的敏感性为85.7%。除两名患者发生中度急性胰腺炎外，未发生重大并发症。
尽管需要对大量患者进行进一步研究，但我们的结果表明，随着刷检技术最近的改进，胰管刷检是一种用于胰腺恶性疾病与良性疾病鉴别诊断的有用且安全的方法。
