Dorrell Robert, Pawa Swati, Zhou Yi, Lalwani Neeraj, Pawa Rishi
Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
Division of Gastroenterology, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
Diagnostics (Basel). 2020 May 25;10(5):337. doi: 10.3390/diagnostics10050337.
The differential diagnosis for biliary strictures is broad. However, the likelihood of malignancy is high. Determining the etiology of a biliary stricture requires a comprehensive physical exam, laboratory evaluation, imaging, and ultimately tissue acquisition. Even then, definitive diagnosis is elusive, and many strictures remain indeterminant in origin. This literary review examines the diagnostic dilemma of biliary strictures and presents innovations in both histochemical and endoscopic techniques that have increased the diagnostic power of differentiating benign and malignant strictures. The field of tissue biopsy is revolutionizing with the advent of free DNA mutation profiling, fluorescence in situ hybridization (FISH), and methionyl t-RNA synthetase 1 (MARS 1), which allow for greater testing sensitivity. Endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), cholangioscopy, confocal laser endomicroscopy, and intraductal ultrasound build upon existing endoscopic technology to better characterize strictures that would otherwise be indeterminate in etiology. This review uses recent literature to insert innovative technology into the traditional framework of diagnostic methods for malignant biliary strictures.
胆管狭窄的鉴别诊断范围很广。然而，恶性病变的可能性很大。确定胆管狭窄的病因需要全面的体格检查、实验室评估、影像学检查，最终还需要获取组织。即便如此，明确诊断仍难以实现，许多狭窄的起源仍不明确。这篇文献综述探讨了胆管狭窄的诊断难题，并介绍了组织化学和内镜技术方面的创新，这些创新提高了鉴别良性和恶性狭窄的诊断能力。随着游离DNA突变分析、荧光原位杂交（FISH）和甲硫氨酰tRNA合成酶1（MARS 1）的出现，组织活检领域正在发生变革，这些技术提高了检测的敏感性。内镜超声、内镜逆行胰胆管造影（ERCP）、胆管镜检查、共聚焦激光显微内镜检查和导管内超声在现有内镜技术的基础上，更好地对病因不明的狭窄进行特征描述。本综述利用近期文献，将创新技术融入恶性胆管狭窄诊断方法的传统框架中。
