Novis Monica, Ardengh José Celso, Libera Ermelindo Della, Nakao Frank Shigueo, Ornellas Laura Cota, Santo Giulio Cesare, Venco Filadelfio, Ferrari Angelo Paulo
Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil.
Rev Col Bras Cir. 2010 Jun;37(3):190-8. doi: 10.1590/s0100-69912010000300006.
To evaluate and to compare the diagnostic yield of ERCP brush cytology (ERCP) and EUS-FNA in patients with biliary strictures and evaluates the agreement between general pathologists (GP) and expert GI pathologists (GIP) in the final diagnosis of biliary strictures.
Patients with biliary strictures documented by ERCP were included. Brush cytology was performed and during EUS, only visible mass lesions or localized bile duct wall thickening were aspirated. The gold standard method for diagnosis was surgical histology and/or follow-up. Tissue sampling results were: malignant, suspicious, atypical, insufficiently or benign. Specimens were interpreted by GP and GIP, blinded for prior tests results.
46 patients were included. Final diagnosis was malignancy in 37 (26 pancreatic--11 biliary) and benign in 9 (8 chronic pancreatitis--1 common bile duct inflammatory stricture). Sensitivity and accuracy for ERCP brush cytology were 43.2% and 52.2% for GP and 51.4% and 58.7% for GIP. Sensitivity and accuracy for EUS-FNA were 52.8% and 58.5%, respectively for GP and 69.4% e 73.2% for GIP. In comparison, the combination of brush cytology and EUS-FNA demonstrated higher sensitivity and accuracy for both GP (64.9% and 69.6%, respectively) and GIP (83.8% and 84.8%, respectively) and improved agreement with final diagnosis for both (mostly for GIP).
Both, ERCP brush cytology and EUS-FNA has a similar yield for the diagnosis of biliary strictures. However, the combination of these methods results in an improved diagnostic accuracy. In addition, GIP might be expected to interpret specimens with greater accuracy than GP.
评估并比较内镜逆行胰胆管造影（ERCP）刷检细胞学检查（ERCP）和超声内镜引导下细针穿刺活检（EUS-FNA）对胆管狭窄患者的诊断效能，并评估普通病理学家（GP）和胃肠病专家病理学家（GIP）在胆管狭窄最终诊断上的一致性。
纳入经ERCP证实存在胆管狭窄的患者。进行刷检细胞学检查，在超声内镜检查期间，仅对可见的肿块病变或局限性胆管壁增厚进行抽吸。诊断的金标准方法是手术组织学检查和/或随访。组织采样结果为：恶性、可疑、非典型、不足或良性。样本由GP和GIP进行解读，他们对先前的检查结果不知情。
纳入46例患者。最终诊断为恶性的有37例（26例胰腺疾病——11例胆管疾病），良性的有9例（8例慢性胰腺炎——1例胆总管炎性狭窄）。GP对ERCP刷检细胞学检查的敏感性和准确性分别为43.2%和52.2%，GIP为51.4%和58.7%。GP对EUS-FNA的敏感性和准确性分别为52.8%和58.5%，GIP为69.4%和73.2%。相比之下，刷检细胞学检查和EUS-FNA联合应用对GP（分别为64.9%和69.6%）和GIP（分别为83.8%和84.8%）均显示出更高的敏感性和准确性，并且二者与最终诊断的一致性均有所提高（对GIP而言提高更为明显）。
ERCP刷检细胞学检查和EUS-FNA对胆管狭窄的诊断效能相似。然而，这两种方法联合应用可提高诊断准确性。此外，预计GIP对样本的解读准确性高于GP。
