Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
Department of Gastroenterology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
Diagn Cytopathol. 2020 Dec;48(12):1230-1236. doi: 10.1002/dc.24553. Epub 2020 Aug 8.
This is the first study to evaluate the accuracy of bile duct brushings since the introduction of single operator cholangioscopy SpyGlass DS system in 2015. The primary aim of our study was to compare the accuracy of cytology brushings against biopsies obtained at endoscopic retrograde cholangiopancreatography (ERCP) and cholangioscopy.
A retrospective search for bile duct brushing specimens was performed and the charts reviewed. The gold standard for definitive diagnosis of malignancy was surgical tissue or compelling clinical evidence of malignancy. Definite negative diagnosis relied on lack of clinical/imaging features of malignancy on follow-up.
There was no significant difference in diagnostic accuracy of cytology specimens obtained at different procedures. Overall sensitivity for all methods was 59%, specificity 90% and accuracy of 82%. Notably, all four false-positive cases except for one were from patients with primary sclerosing cholangitis or primary biliary sclerosis. There was no significant difference in sensitivity or specificity between biopsies procured by the two methods. The combined biopsy sensitivity for all modalities was 44% with a specificity of 100%. There was 70% concordance between cytology and biopsy cases. The overall specificity and sensitivity of the combined cytology and biopsy result was 85% and 65.3%, respectively. Ranking of factors that predict clinical diagnosis shows cytology results to surpass other parameters including pancreatic mass, age and stenosis length. Similarly, the presence of two cell populations and three-dimensional clusters was not nearly as predictive of malignancy as single malignant cells.
Biliary brush cytology specimens performed better than biopsies irrespective of whether they are procured during ERCP or cholangioscopy. The combination of cytology and biopsy had the best accuracy than either one alone.
这是自 2015 年引入单操作员胆管镜 SpyGlass DS 系统以来，第一项评估胆管刷检准确性的研究。我们研究的主要目的是比较细胞学刷检与内镜逆行胰胆管造影（ERCP）和胆管镜检查时获得的活检的准确性。
对胆管刷检标本进行回顾性搜索，并对图表进行了回顾。恶性肿瘤的明确诊断标准是手术组织或恶性肿瘤的明确临床证据。明确的阴性诊断依赖于缺乏恶性肿瘤的临床/影像学特征的随访。
不同操作获得的细胞学标本的诊断准确性无显著差异。所有方法的总体敏感性为 59%，特异性为 90%，准确性为 82%。值得注意的是，除了一例外，所有四个假阳性病例均来自原发性硬化性胆管炎或原发性胆汁性胆管炎患者。两种方法获取的活检的敏感性或特异性均无显著差异。所有方法联合活检的敏感性为 44%，特异性为 100%。细胞学和活检病例之间存在 70%的一致性。细胞学和活检联合结果的总体特异性和敏感性分别为 85%和 65.3%。预测临床诊断的因素排名显示，细胞学结果优于包括胰腺肿块、年龄和狭窄长度在内的其他参数。同样，两个细胞群体和三维簇的存在并不像单个恶性细胞那样具有预测恶性肿瘤的作用。
无论在 ERCP 还是胆管镜检查时进行，胆管刷检细胞学标本的表现均优于活检。细胞学和活检的联合使用比单独使用任何一种方法的准确性都更高。
