Arvanitakis M, Hookey L, Tessier G, Demetter P, Nagy N, Stellke A, De Maertelaer V, Devière J, Le Moine O
Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Endoscopy. 2009 Aug;41(8):696-701. doi: 10.1055/s-0029-1214950. Epub 2009 Jul 17.
Optical coherence tomography (OCT) uses infrared light reflectance to produce high-resolution cross-sectional tissue images. The aim of this study was to demonstrate the feasibility of biliary intraductal OCT during endoscopic retrograde cholangiopancreatography (ERCP) and to assess the potential of the method to detect malignant biliary strictures.
Thirty-seven patients with biliary strictures were studied during therapeutic ERCP. Malignant strictures were defined as those that demonstrated malignant cells in brushing and/or biopsy specimens, and/or endoscopic ultrasound-guided fine-needle aspiration and/or surgery. Strictures that did not have malignant cells in resected specimens and were without clinical/radiological evidence of disease progression for at least a 12-month follow-up period were considered as benign. Two OCT criteria for malignancy were considered: unrecognizable layer architecture; and presence of large, nonreflective areas compatible with tumor vessels. Sensitivity and specificity for brushings/biopsies as well as OCT criteria were calculated.
Nineteen patients had malignant and 16 had benign strictures. In two patients, OCT assessment could not be performed due to tight strictures. Malignancy was confirmed by biliary brushings/biopsies in 12/19 (63 %) patients. OCT revealed that two malignancy criteria were encountered in 10/19 (53 %) and at least one criterion in 15/19 (79 %) patients with malignant strictures. No patient with benign stricture met both criteria and 5/16 met one criterion (31 %). Combining brushings/biopsy with the observation of at least one OCT criterion resulted in the diagnosis of malignancy in 16/19 (84 %) patients.
OCT may improve the sensitivity and diagnostic accuracy of biliary brushings/biopsies alone.
光学相干断层扫描（OCT）利用红外光反射来生成高分辨率的组织横截面图像。本研究的目的是证明在经内镜逆行胰胆管造影术（ERCP）期间进行胆管内OCT的可行性，并评估该方法检测恶性胆管狭窄的潜力。
在治疗性ERCP期间对37例胆管狭窄患者进行了研究。恶性狭窄定义为在刷检和/或活检标本、和/或内镜超声引导下细针穿刺活检和/或手术中发现恶性细胞的狭窄。切除标本中没有恶性细胞且在至少12个月的随访期内没有疾病进展的临床/放射学证据的狭窄被视为良性。考虑了两个OCT恶性标准：无法识别的层结构；以及存在与肿瘤血管相符的大的无反射区域。计算了刷检/活检以及OCT标准的敏感性和特异性。
19例患者为恶性狭窄，16例为良性狭窄。2例患者因狭窄紧密无法进行OCT评估。12/19（63%）例患者经胆管刷检/活检确诊为恶性。OCT显示，10/19（53%）例恶性狭窄患者出现了两个恶性标准，15/19（79%）例患者出现了至少一个标准。没有良性狭窄患者符合两个标准，5/16（31%）例符合一个标准。将刷检/活检与至少一个OCT标准的观察结果相结合，16/19（84%）例患者被诊断为恶性。
OCT可能会提高单独胆管刷检/活检的敏感性和诊断准确性。
