HPB and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, UCL and Royal Free Hospital NHS Trust, London, UK.
HPB (Oxford). 2008;10(2):94-7. doi: 10.1080/13651820801992633.
Surgery is currently the only curative treatment for patients with cholangiocarcinoma (CCA). Whether histological diagnosis of CCA is necessary before surgery is controversial. Fifteen percent of patients with suspected biliary malignancy who undergo surgery are found to have benign disease. Surgery is a major procedure with significant morbidity and mortality and alternative treatment is available for those known to have benign stenoses. The aim of this review was to determine whether any of the current diagnostic tests have sufficient sensitivity and specificity to identify patients with benign and malignant bile duct stenoses. A literature search was performed until July 2007 to obtain information from studies published in the previous 10 years. Only studies reporting an appropriate reference test (confirmation of malignancy by biopsy, confirmation of benign nature by histology following surgical excision, or at least 6 months of follow-up for all patients) were included for review. The diagnostic odds ratio was used to measure diagnostic performance. Forty-one references of 34 studies were included in this review. None of the studies used differential verification. Six studies used blinding of assessor. None of the diagnostic tests had sufficient diagnostic accuracy to reliably separate patients with benign from malignant biliary strictures. Differentiating benign from malignant bile strictures is an important aim. There is no trial evidence demonstrating benefit in obtaining a preoperative histological diagnosis of CCA. New methods are required for stricture assessment.
手术目前是胆管癌（CCA）患者唯一的根治性治疗方法。在手术前是否需要对 CCA 进行组织学诊断存在争议。在接受疑似胆道恶性肿瘤手术的患者中，有 15%的患者被发现患有良性疾病。手术是一种具有重大发病率和死亡率的主要程序，对于那些已知患有良性狭窄的患者，可以采用替代治疗方法。本综述的目的是确定目前的任何诊断测试是否具有足够的敏感性和特异性来识别患有良性和恶性胆管狭窄的患者。进行了文献检索，直到 2007 年 7 月，以获取过去 10 年发表的研究报告的信息。仅纳入了报告适当参考测试（通过活检确认恶性，通过手术切除后的组织学确认良性，或对所有患者进行至少 6 个月的随访）的研究进行综述。使用诊断比值比来衡量诊断性能。本综述共纳入了 34 项研究的 41 篇参考文献。没有一项研究使用差异验证。有 6 项研究采用了评估者盲法。没有任何诊断测试具有足够的诊断准确性来可靠地区分良性和恶性胆管狭窄患者。区分良性和恶性胆汁狭窄是一个重要的目标。没有试验证据表明术前获得 CCA 的组织学诊断有获益。需要新的方法来评估狭窄。
