可疑恶性胆道狭窄经内镜逆行胰胆管造影引导下经乳头胆管内超声引导下活检与常规活检的前瞻性比较。

Prospective Comparison of Intraductal Ultrasonography-Guided Transpapillary Biopsy and Conventional Biopsy on Fluoroscopy in Suspected Malignant Biliary Strictures.

机构信息

Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea.

Department of Pathology, Soonchunhyang University School of Medicine, Bucheon, Korea.

出版信息

Gut Liver. 2018 Jul 15;12(4):463-470. doi: 10.5009/gnl17205.

BACKGROUND/AIMS: In suspected malignant biliary strictures (MBSs), the diagnostic yield of endoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling is limited. Transpapillary forceps biopsy (TPB) under intraductal ultrasonography (IDUS) guidance is expected to improve the diagnostic accuracy in patients with indeterminate biliary strictures. We evaluated the usefulness of IDUS-guided TPB in patients with suspected MBS.

METHODS

Consecutive patients with suspected MBS were prospectively enrolled in the study. ERCP with IDUS was performed in all patients. Both conventional TPB and IDUS-guided TPB on fluoroscopy were performed in each patient. The primary outcome was the diagnostic accuracy of conventional TPB and IDUS-guided TPB.

RESULTS

The technical success rate of IDUS-guided TPB was 97.0% (65/67 patients). Of these 65 patients, the final diagnosis was malignancy in 61 patients (93.8%). On IDUS, the most common finding of IDUS was an intraductal infiltrating lesion in 29 patients (47.5%). The overall diagnostic accuracy was significantly higher using IDUS-guided TPB than that using conventional TPB (90.8% vs 76.9%, p=0.027). According to the subgroup analysis based on the tumor morphology, IDUS-guided TPB had a significantly higher cancer detection rate than conventional TPB for intraductal infiltrating lesions (89.6% vs 65.5%, p=0.028).

CONCLUSIONS

IDUS-guided TPB appears to improve the accuracy of histological diagnosis in patients with MBS.

背景/目的：在内镜逆行胰胆管造影术（ERCP）为基础的组织取样中，疑似恶性胆道狭窄（MBS）的诊断率有限。在胆管内超声（IDUS）引导下进行经乳头钳活检（TPB）有望提高对不确定胆道狭窄患者的诊断准确性。我们评估了 IDUS 引导下 TPB 在疑似 MBS 患者中的应用价值。

方法

连续前瞻性纳入疑似 MBS 的患者。所有患者均进行 ERCP 联合 IDUS。每位患者均进行常规 TPB 和透视下 IDUS 引导 TPB。主要结局是常规 TPB 和 IDUS 引导 TPB 的诊断准确性。

结果

IDUS 引导 TPB 的技术成功率为 97.0%（67/67 例患者）。这 65 例患者中，最终诊断为恶性肿瘤的有 61 例（93.8%）。在 IDUS 上，最常见的 IDUS 表现为 29 例（47.5%）的腔内浸润性病变。与常规 TPB 相比，IDUS 引导 TPB 的整体诊断准确性显著更高（90.8% vs. 76.9%，p=0.027）。根据基于肿瘤形态的亚组分析，对于腔内浸润性病变，IDUS 引导 TPB 的癌症检出率明显高于常规 TPB（89.6% vs. 65.5%，p=0.028）。