Archibugi Livia, Mariani Alberto, Ciambriello Biagio, Petrone Maria Chiara, Rossi Gemma, Testoni Sabrina Gloria Giulia, Carlucci Michele, Aldrighetti Luca, Falconi Massimo, Balzano Gianpaolo, Doglioni Claudio, Capurso Gabriele, Arcidiacono Paolo Giorgio
Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Digestive Endoscopy AO Specialistica Dei Colli CTO, Naples, Italy.
Endosc Int Open. 2021 Mar;9(3):E363-E370. doi: 10.1055/a-1322-2638. Epub 2021 Feb 19.
Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in biliary strictures, with brushing being a cheap and fast method to acquire a cytological specimen, despite a sensitivity around 45 %. Rapid on-site evaluation (ROSE) is widely used for endoscopic ultrasound-acquired cytological specimen adequacy, improving its sensitivity and specificity. Nevertheless, no study has evaluated its role for ERCP-guided brushing. Our aim was to assess the diagnostic yield of ERCP-guided brushing of biliary strictures when supported by ROSE. This was a retrospective single-center study that included patients undergoing ERCP-guided brush cytology supported by ROSE for biliary strictures. Recorded data included patient clinical-radiological and ERCP features. Final diagnosis was determined after surgery, intraductal biopsy or adequate follow-up. The diagnostic yield was calculated and a subgroup analysis for factors associated with false-negative or true-positive results was performed. Two hundred six patients were included, 57.3 % males, median age 72 years, 77.2 % having extrahepatic biliary strictures. Of the patients, 99 % had an adequate sample at ROSE after a mean of 2.6 passages. The diagnostic yield was accuracy 83 %, sensitivity 74.6 %, and specificity 98 %, positive and negative predictive values 98 % and 71 % respectively, with an area under the curve of 0.86. A diagnosis of cholangiocarcinoma was significantly more frequent among true-positive cases (68 % vs 46.8 %; = 0.04). This is the first study evaluating the use of ROSE as support for ERCP-guided brushing of biliary strictures, with a sensitivity far higher than those reported for brushing alone and at least comparable to those of more expensive and invasive techniques.
内镜逆行胰胆管造影术（ERCP）在胆管狭窄的诊治中发挥着重要作用，刷检是获取细胞学标本的一种廉价且快速的方法，尽管其敏感性约为45%。快速现场评估（ROSE）广泛用于评估内镜超声获取的细胞学标本是否足够，可提高其敏感性和特异性。然而，尚无研究评估其在ERCP引导下刷检中的作用。我们的目的是评估在ROSE支持下ERCP引导下胆管狭窄刷检的诊断率。
这是一项回顾性单中心研究，纳入了接受ROSE支持的ERCP引导下胆管狭窄刷检细胞学检查的患者。记录的数据包括患者的临床影像学和ERCP特征。最终诊断在手术后、导管内活检或充分随访后确定。计算诊断率，并对与假阴性或真阳性结果相关的因素进行亚组分析。
共纳入206例患者，男性占57.3%，中位年龄72岁，77.2%患有肝外胆管狭窄。其中，99%的患者在平均2.6次取材后ROSE获得了足够的样本。诊断率为：准确率83%，敏感性74.6%，特异性98%，阳性预测值和阴性预测值分别为98%和71%，曲线下面积为0.86。在真阳性病例中，胆管癌的诊断明显更常见（68%对46.8%；P = 0.04）。
这是第一项评估ROSE作为ERCP引导下胆管狭窄刷检支持手段的研究，其敏感性远高于单独刷检报道的敏感性，且至少与更昂贵和侵入性更强的技术相当。
