Liu R, Cox Rn K, Siddiqui A, Feurer M, Baron T, Adler D G
Division of Gastroenterology and Hepatology Department of Internal Medicine, University of Utah School of Medicine Salt Lake City, UT, USA -
Minerva Gastroenterol Dietol. 2014 Jun;60(2):127-33.
Biliary strictures that are suspicious for cholangiocarcinoma (CCA) are commonly encountered in clinical practice in patients with and without primary sclerosing cholangitis (PSC). A definitive histologic diagnosis of CCA via endoscopic retrograde cholangiography (ERCP) is often not obtainable with standard biliary brush cytology. Peroral cholangioscopy is an additional tool to help provide a diagnosis of CCA in patients with suspicious biliary strictures. Aim of the study was to assess the use of peroral cholangioscopy in patients with and without PSC and indeterminate biliary strictures.
Retrospective study.
25 patients were included in the study. All patients underwent ERCP with peroral cholangioscopy. Tissue samples obtained included routine cytology, fluorescent in-situ hybridization, and cholangioscopic-directed forceps biopsies. The operating characteristics of cholangioscopy to detect malignancy in 18 PSC patients with suspected cholangiocarcinoma were a sensitivity of 75%, specificity of 55%, and a positive predictive value (PPV) of 23%, and a negative predictive value of 92%. In 7 non-PSC patients with suspected cholangiocarcinoma these values sensitivity=100%, 25%, 50%, and NPV=100%, respectively. The overall operating characteristics of cholangioscopy to detect malignancy in all 25 patients with suspected cholangiocarcinoma were: sensitivity of 86%, specificity of 50%, PPV of 32%, and NPV of 93%.
Cholangioscopy helps identify sites for tissue acquisition in PSC and non-PSC patients with biliary strictures suspicious for malignancy.
在患有和未患有原发性硬化性胆管炎（PSC）的患者的临床实践中，经常会遇到疑似胆管癌（CCA）的胆管狭窄。通过内镜逆行胆管造影（ERCP）获得CCA的明确组织学诊断通常无法通过标准胆管刷检细胞学实现。经口胆管镜检查是一种辅助工具，有助于对疑似胆管狭窄的患者进行CCA诊断。本研究的目的是评估经口胆管镜检查在患有和未患有PSC且胆管狭窄不明确的患者中的应用。
回顾性研究。
25例患者纳入研究。所有患者均接受了ERCP及经口胆管镜检查。获取的组织样本包括常规细胞学检查、荧光原位杂交以及胆管镜引导下的钳取活检。在18例疑似胆管癌的PSC患者中，胆管镜检查检测恶性肿瘤的操作特征为：敏感性75%，特异性55%，阳性预测值（PPV）23%，阴性预测值92%。在7例疑似胆管癌的非PSC患者中，这些值分别为敏感性=100%，25%，50%，阴性预测值=100%。在所有25例疑似胆管癌患者中，胆管镜检查检测恶性肿瘤的总体操作特征为：敏感性86%，特异性50%，PPV 32%，阴性预测值93%。
胆管镜检查有助于在患有和未患有PSC且胆管狭窄疑似恶性肿瘤的患者中确定组织获取部位。
