Temiño López-Jurado R, Cacho Acosta G, Argüelles Pintos M, Rodríguez Caravaca G, Lledó Navarro J L, Fernández Rodríguez C
Unit of Digestive Diseases, Hospital Universitario Fundación Alcorcón, Madrid.
Rev Esp Enferm Dig. 2009 Jun;101(6):385-9, 390-4. doi: 10.4321/s1130-01082009000600003.
To evaluate the diagnostic yield of brush cytology for biliary strictures detected on ERCP when a systematic approach is used.
Data on 62 consecutive patients with a biliary stricture on ERCP were collected. Cytological samples were processed immediately after brushing in the endoscopy room, and all were analyzed by the same pathologist. For the statistical analysis specimens were classified as positive, negative, suspicious for malignancy (presence of atypias), and unsatisfactory for evaluation. Final diagnosis was based on either histopathologic (surgery or biopsies by other techniques) or clinical/radiographic diagnosis.
A total of 71 cytological specimens were included. Definite diagnosis was malignancy in 49 samples, and benign stricture in 22. Three samples were excluded because of insufficient material or processing artifacts. The sensitivity of biliary brushing was 62% (95% CI 0.47-0.77), specificity was 100%, positive predictive value was 100%, and negative predictive value was 58% (95% CI 0.43-0.75). When suspicious samples were included as malignant, sensitivity was 67% (95% CI 0.54-0.81) without changes in the remaining parameters. Eight patients underwent more than one ERCP. Repeated brush cytology exams in these patients yielded a definitive diagnosis in every case.
Brush cytology has intermediate sensitivity with a high specificity. A systematic approach with a dedicated pathologist and the inclusion of significant atypias as malignant results improves sensitivity. Due to its simplicity brush cytology should be performed in all cases of biliary strictures detected on ERCP, and in case of repeated ERCPs additional cytology brushings are recommended.
评估采用系统方法时，内镜逆行胰胆管造影（ERCP）检查发现的胆管狭窄的刷检细胞学诊断率。
收集了62例经ERCP检查发现胆管狭窄的连续患者的数据。细胞学样本在胃镜检查室刷取后立即进行处理，所有样本均由同一位病理学家进行分析。为进行统计分析，标本分为阳性、阴性、可疑恶性（存在异型性）和评估不满意四类。最终诊断基于组织病理学（手术或其他技术活检）或临床/影像学诊断。
共纳入71份细胞学标本。49份样本确诊为恶性，22份为良性狭窄。3份样本因材料不足或处理假象而被排除。胆管刷检的敏感性为62%（95%可信区间0.47 - 0.77），特异性为100%，阳性预测值为100%，阴性预测值为58%（95%可信区间0.43 - 0.75）。当将可疑样本视为恶性时，敏感性为67%（95%可信区间0.54 - 0.81），其余参数无变化。8例患者接受了不止一次ERCP检查。这些患者重复进行刷检细胞学检查，每次均得出明确诊断。
刷检细胞学具有中等敏感性和高特异性。由专业病理学家采用系统方法，并将显著异型性视为恶性结果，可提高敏感性。由于其操作简单，对于ERCP检查发现的所有胆管狭窄病例均应进行刷检细胞学检查，对于重复进行ERCP检查的情况，建议再次进行细胞学刷检。
