Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA.
Investigative Medicine Program, Yale Center of Clinical Investigation, New Haven, CT, USA.
Aliment Pharmacol Ther. 2016 Dec;44(11-12):1139-1151. doi: 10.1111/apt.13817. Epub 2016 Oct 3.
The accuracy of current endoscopic modalities for diagnosing cholangiocarcinoma in primary sclerosing cholangitis (PSC) is suboptimal.
To evaluate the comparative effectiveness of endoscopic retrograde cholangiopancreatography (ERCP)-based modalities, independently or in combination, for the diagnosis of cholangiocarcinoma in patients with PSC-induced biliary strictures.
Searches of PubMed, EMBASE, Web of Science and the Cochrane Library databases were performed through December 2015. Measured outcomes included sensitivity and specificity of all diagnostic modalities independently or in combination. A bivariate model was used to compute the pooled sensitivity and specificity, and to plot the summary receiver operating characteristics curve with summary point and corresponding 95% confidence interval (95% CI). A logistic regression model was used to impute the incremental performance of combining two diagnostic tests.
Twenty-one studies met inclusion criteria: 13 on bile duct brushing for cytology, 7 on fluorescence in situ hybridisation (FISH), 2 on probe-based confocal laser endomicroscopy, and 4 on single-operator cholangioscopy with targeted biopsies. Single-operator cholangioscopy with targeted biopsies was the most accurate diagnostic modality at 96% (95% CI, 94-97%). The pooled sensitivity and specificity of single-operator cholangioscopy for diagnosis of cholangiocarcinoma in patients with PSC was 65% (95% CI, 35-87%) and 97% (95% CI, 87-99%), respectively. The pooled diagnostic odds ratio to detect cholangiocarcinoma was 59 (95% CI, 10-341).
Single-operator cholangioscopy with targeted biopsies appears to be the most accurate ERCP-based modality for diagnosing cholangiocarcinoma in primary sclerosing cholangitis. However, future large, well-designed comparative diagnostic studies are warranted to validate these findings.
目前内镜方法诊断原发性硬化性胆管炎（PSC）相关胆管癌的准确性并不理想。
评估单独或联合应用内镜逆行胰胆管造影（ERCP）为基础的方法对PSC 所致胆道狭窄患者胆管癌的诊断效果。
检索 2015 年 12 月前PubMed、EMBASE、Web of Science 和 Cochrane 图书馆数据库。主要研究结果包括所有诊断方法单独或联合应用的敏感度和特异度。应用双变量模型计算汇总敏感度和特异度，并绘制汇总受试者工作特征曲线及其汇总点和相应的 95%置信区间（95%CI）。应用逻辑回归模型推断两种诊断方法联合应用的增量性能。
21 项研究符合纳入标准：13 项关于胆管刷检细胞学检查，7 项关于荧光原位杂交（FISH），2 项关于基于探头的共聚焦激光内镜检查，4 项关于单操作者胆道镜靶向活检。单操作者胆道镜靶向活检是最准确的诊断方法，其敏感度和特异度分别为 96%（95%CI，94%-97%）和 97%（95%CI，87%-99%）。PSC 患者单操作者胆道镜诊断胆管癌的汇总敏感度和特异度分别为 65%（95%CI，35%-87%）和 97%（95%CI，87%-99%）。诊断胆管癌的汇总优势比为 59（95%CI，10-341）。
单操作者胆道镜靶向活检似乎是 ERCP 为基础诊断 PSC 相关胆管癌最准确的方法。但是，需要未来进行更大规模、精心设计的比较诊断研究来验证这些发现。
