Costa Mariana, Canena Jorge, Mascarenhas-Lemos Luís, Loureiro Rafaela, Silva Mário, Carvalho Diana, Capela Tiago, Russo Pedro, Ramos Gonçalo, Mateus-Dias António, Ferraz-Oliveira Mário, Veiga Pedro Mota, Coimbra João
Department of Gastroenterology, Santo António dos Capuchos Hospital do Centro Hospitalar Lisboa Central, Nova Medical School/Faculty of Medical Sciences, Lisbon, Portugal.
CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.
GE Port J Gastroenterol. 2018 Dec;26(1):5-13. doi: 10.1159/000487153. Epub 2018 Feb 28.
Brush cytology during endoscopic retrograde cholangiopancreatography (ERCP) is the most frequently used strategy for obtaining a tissue sample from an indeterminate biliary stricture. A recent study reported that age is a factor associated with positive yields, but further analysis of how age influences the results was lacking. We aimed to evaluate clinical effectiveness of biliary cytology and prognostic factors for a positive outcome, especially age.
This study was a single-center, retrospective, clinical study of 77 consecutive patients who underwent brush cytology during ERCP to obtain a diagnosis of an indeterminate biliary stricture. We compared 2 routine cytology techniques: A (smear); B (centrifugation of the cytological material collected and the cut-off brush + cell block when sufficient amount of material was available). The data were collected aiming to compare the accuracy of the different techniques used and the prognostic factors affecting the outcome, with a particular focus on age. The yield for brush cytology was compared with the gold standard defined as either definitive histology or the long-term clinical course.
The overall accuracy of the 2 used methods was 75.3%. Sensitivity was 52.5%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 66.1%. Although not statistically significant, there was a trend toward accuracy for method B compared with method A (80.4 vs. 65.4%; = 0.153). Multiple logistic regression analysis showed that younger age was the only independent prognostic factor associated with a positive diagnosis (OR 0.95; 95% CI 0.90-0.99; = 0.039). Receiver operating characteristic curves for age yielded an area under the curve value of 68.2%. On the basis of the Youden index, 69 years was found to be the optimal cutoff for age.
In this series, the accuracy of routine biliary brush cytology was not equal for all methods and ages; in particular, younger patients (below 69 years) tended to have a higher probability of a correct diagnosis.
内镜逆行胰胆管造影术（ERCP）期间的刷检细胞学检查是从不确定的胆管狭窄处获取组织样本最常用的方法。最近一项研究报告称年龄是与阳性检出率相关的一个因素，但缺乏对年龄如何影响结果的进一步分析。我们旨在评估胆管细胞学检查的临床有效性及阳性结果的预后因素，尤其是年龄。
本研究是一项单中心、回顾性临床研究，纳入了77例连续接受ERCP期间刷检细胞学检查以诊断不确定胆管狭窄的患者。我们比较了2种常规细胞学技术：A（涂片）；B（收集的细胞学材料离心，当有足够材料时对截断刷 + 细胞块进行处理）。收集数据旨在比较所使用的不同技术的准确性以及影响结果的预后因素，特别关注年龄。将刷检细胞学检查的检出率与定义为明确组织学或长期临床病程的金标准进行比较。
所使用的2种方法的总体准确率为75.3%。敏感性为52.5%，特异性为100%，阳性预测值为100%，阴性预测值为66.1%。虽然无统计学意义，但与方法A相比，方法B有准确率更高的趋势（80.4%对65.4%；P = 0.153）。多因素逻辑回归分析显示，年龄较小是与阳性诊断相关的唯一独立预后因素（OR 0.95；95%CI 0.90 - 0.99；P = 0.039）。年龄的受试者工作特征曲线下面积值为68.2%。基于约登指数，发现69岁是年龄的最佳截断值。
在本系列研究中，常规胆管刷检细胞学检查的准确性在所有方法和年龄中并不相同；特别是年轻患者（69岁以下）正确诊断的概率往往更高。
