Division of Gastroenterology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Division of Gastroenterology, American University of Beirut, Beirut, Lebanon.
Endosc Ultrasound. 2013 Apr;2(2):71-6. doi: 10.4103/2303-9027.117690.
Cholangiocarcinoma is a malignancy that arises from biliary epithelium and is associated with a poor prognosis. Accurate preopera-tive diagnosis and staging of cholangiocarcinoma continues to remain difficult. Endoscopic retrograde cholangiopancreatography (ERCP) is the most commonly performed procedure for cholangiocarcinoma and can provide a tissue diagnosis through brush cytology of the bile duct. However, the sensitivity of biliary brush cytology to diagnose cholangiocarcinoma may be as low as 30%. Endoscopic ultrasound (EUS) is a diagnostic modality which may overcome the limitations of other imaging and biopsy techniques in this setting. EUS can complement the role of ERCP and provide a tissue diagnosis through fine needle aspiration (FNA) and staging through ultrasound imaging. There is currently a paucity of data about the exact role of EUS for the diagnosis of cholan-giocarcinoma in patients with indeterminate extrahepatic biliary strictures. Although multiple studies have shown that EUS is more accurate than ERCP and radiologic imaging for identifying a biliary mass and diagnosing cholangiocarcinoma, the sensitivities are variable. More importantly, the incidence of false negative results is not negligible, though the specificity is close to 100%. There is also controversy regarding the role of EUS-FNA, since even though this may increase diagnosis, it can also lead to tumor seeding.
胆管癌是一种起源于胆道上皮的恶性肿瘤，预后较差。准确的术前诊断和分期仍然很困难。经内镜逆行胰胆管造影术（ERCP）是诊断胆管癌最常用的方法，可以通过胆管刷检细胞学获得组织诊断。然而，胆管刷检细胞学诊断胆管癌的敏感性可能低至 30%。内镜超声（EUS）是一种诊断方法，可能克服其他成像和活检技术在这种情况下的局限性。EUS 可以补充 ERCP 的作用，通过细针抽吸（FNA）获得组织诊断，并通过超声成像进行分期。目前关于 EUS 在诊断不确定的肝外胆管狭窄患者中的胆管癌的确切作用的数据很少。尽管多项研究表明，EUS 比 ERCP 和影像学检查更能准确识别胆道肿块和诊断胆管癌，但敏感性各不相同。更重要的是，假阴性结果的发生率不容忽视，尽管特异性接近 100%。对于 EUS-FNA 的作用也存在争议，因为即使这可能增加诊断，但也可能导致肿瘤播散。
