Levy Michael J, Baron Todd H, Clayton Amy C, Enders Felicity B, Gostout Christopher J, Halling Kevin C, Kipp Benjamin R, Petersen Bret T, Roberts Lewis R, Rumalla Ashwin, Sebo Thomas J, Topazian Mark D, Wiersema Maurits J, Gores Gregory J
Division of Gastroenterology and Hepatology, Mayo Clinic Foundation, Rochester, Minnesota, USA.
Am J Gastroenterol. 2008 May;103(5):1263-73. doi: 10.1111/j.1572-0241.2007.01776.x.
Standard techniques for evaluating bile duct strictures have poor sensitivity for detection of malignancy. Newer imaging modalities, such as intraductal ultrasound (IDUS), and advanced cytologic techniques, such as digital image analysis (DIA) and fluorescence in situ hybridization (FISH), identify chromosomal abnormalities, and may improve sensitivity while maintaining high specificity. Our aim was to prospectively evaluate the accuracy of these techniques in patients with indeterminate biliary strictures.
Cholangiography, routine cytology (RC), intraductal biopsy, DIA, FISH, and IDUS were performed in 86 patients with indeterminate biliary strictures. Patients were stratified based on the presence or absence of primary sclerosing cholangitis (PSC).
RC provided low sensitivity (7-33%) but high specificity (95-100%) for PSC and non-PSC patients. The composite DIA/FISH results (when considering trisomy-7 [Tri-7] as a marker of benign disease) yielded a 100% specificity and increased sensitivity one- to fivefold in PSC patients versus RC, and two- to fivefold in patients without PSC, depending on how suspicious cytology results were interpreted. For the most difficult-to-manage patients with negative cytology and histology who were later proven to have malignancy (N = 21), DIA, FISH, composite DIA/FISH, and IDUS were able to predict malignant diagnoses in 14%, 62%, 67%, and 86%, respectively.
DIA, FISH, and IDUS enhance the accuracy of standard techniques in evaluation of indeterminate bile duct strictures, allowing diagnosis of malignancy in a substantial number of patients with false-negative cytology and histology. These findings support the routine use of these newer diagnostic modalities in patients with indeterminate biliary strictures.
评估胆管狭窄的标准技术对恶性肿瘤检测的敏感性较差。较新的成像方式，如导管内超声（IDUS），以及先进的细胞学技术，如数字图像分析（DIA）和荧光原位杂交（FISH），可识别染色体异常，可能在保持高特异性的同时提高敏感性。我们的目的是前瞻性评估这些技术在胆管狭窄诊断不明确患者中的准确性。
对86例胆管狭窄诊断不明确的患者进行了胆管造影、常规细胞学检查（RC）、导管内活检、DIA、FISH和IDUS检查。根据是否存在原发性硬化性胆管炎（PSC）对患者进行分层。
RC对PSC和非PSC患者的敏感性较低（7-33%），但特异性较高（95-100%）。DIA/FISH综合结果（将7号染色体三体[Tri-7]视为良性疾病的标志物）的特异性为100%，与RC相比，PSC患者的敏感性提高了1至5倍，非PSC患者的敏感性提高了2至5倍，具体取决于对可疑细胞学结果的解释方式。对于细胞学和组织学检查均为阴性、后来被证实患有恶性肿瘤的最难处理的患者（N = 21），DIA、FISH、DIA/FISH综合检查和IDUS分别能够在14%、62%、67%和86%的患者中预测恶性诊断。
DIA、FISH和IDUS提高了标准技术在评估胆管狭窄诊断不明确患者中的准确性，使大量细胞学和组织学检查为假阴性的患者能够诊断出恶性肿瘤。这些发现支持在胆管狭窄诊断不明确的患者中常规使用这些较新的诊断方式。
