Taunk Pushpak, Singh Satish, Lichtenstein David, Joshi Virendra, Gold Jason, Sharma Ashish
University of South Florida, Tampa, Florida, USA.
Boston University Medical Center, Boston, Massachusetts, USA.
J Gastroenterol Hepatol. 2017 Oct;32(10):1778-1783. doi: 10.1111/jgh.13782.
Probe-based confocal laser endomicroscopy (pCLE) using the Miami Criteria has improved classification of indeterminate biliary strictures. However, previous biliary stenting may result in their misclassification as malignant strictures. Inflammatory criteria were added to form the Paris Classification to prevent this misclassification and reduce false positives. The aim of this study was to assess if the Paris Classification was more accurate than the Miami Classification in classifying indeterminate biliary strictures after biliary stenting.
This was a retrospective observational study involving 21 patients with indeterminate biliary strictures from whom 27 pCLE video sequences were obtained (20 benign and seven malignant). Patients with and without prior biliary stenting underwent pCLE. Two investigators classified the strictures as malignant or benign using the Miami and Paris Classifications. Diagnostic accuracy, sensitivity (Se), and specificity (Sp) of endoscopic retrograde-guided pCLE were compared with final histopathology.
In those without biliary stenting, the Miami Criteria resulted in Se 88%, Sp 75%, positive predictive value (PPV) 64%, negative predictive value (NPV) 92%, and accuracy 79%, while the Paris Classification resulted in Se 63%, Sp 88%, PPV 71%, NPV 82%, and accuracy 79%. In those with prior biliary stenting, the Miami Criteria resulted in Se 88%, Sp 36%, PPV 23%, NPV 93%, and accuracy 45%, while the Paris Classification resulted in Se 63%, Sp 73%, PPV 31%, NPV 91%, and accuracy 71%. The kappa statistic was 0.56.
The Paris Classification improved specificity and accuracy of biliary stricture classification in those who had been previously stented and decreased the rate of misclassification of benign strictures as malignant.
采用迈阿密标准的基于探头的共聚焦激光内镜检查（pCLE）改善了不确定胆管狭窄的分类。然而，先前的胆管支架置入术可能导致其被误分类为恶性狭窄。添加了炎症标准以形成巴黎分类，以防止这种误分类并减少假阳性。本研究的目的是评估巴黎分类在对胆管支架置入术后的不确定胆管狭窄进行分类时是否比迈阿密分类更准确。
这是一项回顾性观察研究，纳入了21例不确定胆管狭窄患者，共获得27个pCLE视频序列（20个良性和7个恶性）。有或无先前胆管支架置入术的患者均接受了pCLE检查。两名研究人员使用迈阿密和巴黎分类将狭窄分为恶性或良性。将内镜逆行引导下pCLE的诊断准确性、敏感性（Se）和特异性（Sp）与最终组织病理学结果进行比较。
在未进行胆管支架置入术的患者中，迈阿密标准的Se为88%，Sp为75%，阳性预测值（PPV）为64%，阴性预测值（NPV）为92%，准确性为79%，而巴黎分类的Se为63%，Sp为88%，PPV为71%，NPV为82%，准确性为79%。在先前有胆管支架置入术的患者中，迈阿密标准的Se为88%，Sp为36%，PPV为23%，NPV为93%，准确性为45%，而巴黎分类的Se为63%，Sp为73%，PPV为31%，NPV为91%，准确性为71%。kappa统计量为0.56。
巴黎分类提高了先前置入支架患者胆管狭窄分类的特异性和准确性，并降低了良性狭窄被误分类为恶性的发生率。
