Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Dig Dis Sci. 2020 May;65(5):1471-1478. doi: 10.1007/s10620-019-05866-2. Epub 2019 Sep 30.
Single-operator cholangioscopy (SOC) has been suggested to be a cost-effective strategy for the detection of cholangiocarcinoma (CCA). The aim of this study is to compare the performance characteristics of SOC-guided biopsies and transpapillary biopsies with standard sampling techniques for the detection of CCA.
A retrospective cohort study of patients undergoing SOC between 1/2007 and 10/2018 at a single academic center was performed. Demographic, procedural, and outcomes data were recorded and analyzed using STATA 14.0. Sensitivity comparison between diagnostic tests was performed using exact McNemar test exclusively among patients with CCA. Two-sided p value < 0.05 was considered statistically significant.
Ninety-two patients were included; 36 (39.1%) with primary sclerosing cholangitis (PSC), 41 (44.6%) with CCA, and median follow-up was 15.1 months. In the overall cohort, brush cytology demonstrated a sensitivity of 44.7% and increased with the addition of FISH (56.8%; p = 0.12), FISH with SOC-guided biopsy (71.4%; p = 0.03), and FISH with transpapillary biopsy (64.5%; p = 0.01). However, in patients with PSC, there was no significant improvement in sensitivity with the addition of SOC-guided biopsy or transpapillary biopsy in addition to FISH when compared to brush cytology. There was no difference in the rates of overall adverse events (14% vs. 23.2%; p = 0.27) or infection (3% vs. 4%; p = 0.83) in patients with and without PSC.
SOC-guided and transpapillary biopsies improve sensitivity for the detection of cholangiocarcinoma in combination with other ERCP-based techniques compared to brush cytology alone. However, while safe, these modalities do not significantly improve the sensitivity for the detection of malignancy in PSC patients.
单操作员胆管镜检查（SOC）被认为是一种具有成本效益的策略，可用于检测胆管癌（CCA）。本研究的目的是比较 SOC 引导下活检和经乳头活检与标准采样技术在检测 CCA 方面的性能特征。
对 2007 年 1 月至 2018 年 10 月在一家学术中心接受 SOC 的患者进行了回顾性队列研究。使用 STATA 14.0 记录和分析人口统计学、程序和结果数据。仅在患有 CCA 的患者中，使用精确 McNemar 检验比较诊断测试之间的敏感性。双侧 p 值<0.05 被认为具有统计学意义。
共纳入 92 例患者，其中 36 例（39.1%）患有原发性硬化性胆管炎（PSC），41 例（44.6%）患有 CCA，中位随访时间为 15.1 个月。在整个队列中，刷检细胞学显示出 44.7%的敏感性，并且随着 FISH 的加入而增加（56.8%；p=0.12）、FISH 联合 SOC 引导活检（71.4%；p=0.03）和 FISH 联合经乳头活检（64.5%；p=0.01）。然而，在 PSC 患者中，与刷检细胞学相比，SOC 引导活检或经乳头活检联合 FISH 的加入并未显著提高敏感性。在有和没有 PSC 的患者中，总不良事件的发生率（14%比 23.2%；p=0.27）或感染率（3%比 4%；p=0.83）没有差异。
与单独刷检细胞学相比，SOC 引导下和经乳头活检联合其他 ERCP 技术可提高 CCA 的检测敏感性。然而，虽然安全，但这些方法并不能显著提高 PSC 患者检测恶性肿瘤的敏感性。
