Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Gastrointest Endosc. 2021 Oct;94(4):733-741.e4. doi: 10.1016/j.gie.2021.04.026. Epub 2021 May 6.
Endobiliary brushings are routinely used in the diagnosis, treatment, and prognostication of biliary strictures. However, standard Papanicolaou (Pap) staining has a low sensitivity in this setting, and the accuracy of brush cytology has not been established for indeterminate strictures. We therefore evaluated the diagnostic merit of methionyl-transfer RNA synthetase 1 (MARS1) immunofluorescence (IF) staining in such cytologic specimens.
During ERCP, endobiliary brushings were obtained from patients with extrahepatic biliary strictures prospectively enrolled at 6 tertiary hospitals. Using liquid-based cytologic preparations of these samples, we performed Pap and MARS1 IF staining.
In total, 240 patients were eligible; of these, we compared the Pap and MARS1 IF staining results of 218 (malignant, 157; benign, 61). By conventional Pap staining, the diagnoses were distributed as follows: malignant, 55; suspicious of malignancy, 60; atypical, 45; negative for malignancy, 58. MARS1 IF staining was strongly positive in malignant biliary stricture but not so in specimens negative for malignancy. The diagnostic parameters (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of the MARS1 IF (93.6%, 96.7%, 98.7%, 85.5%, and 94.5%, respectively) and conventional Pap (73.2%, 100%, 100%, 59.2%, and 80.7%, respectively) staining methods differed significantly (P < .0001).
The high sensitivity and accuracy of MARS1 IF staining enabled the detection of malignancy in patients with biliary strictures. Further prospective studies are needed to validate our findings. (Clinical trial registration number: NCT03708445.).
胆管内刷检常用于胆管狭窄的诊断、治疗和预后判断。然而，在这种情况下，标准巴氏染色的敏感性较低，并且刷取细胞学检查对不确定狭窄的准确性尚未确定。因此，我们评估了甲硫氨酰-tRNA 合成酶 1（MARS1）免疫荧光（IF）染色在这种细胞学标本中的诊断价值。
在 6 家三级医院前瞻性纳入的肝外胆管狭窄患者行 ERCP 时，我们获取胆管内刷检标本。使用这些样本的液基细胞学制备物，我们进行了巴氏和 MARS1 IF 染色。
共有 240 例患者符合条件；其中，我们比较了 218 例（恶性 157 例，良性 61 例）患者的巴氏和 MARS1 IF 染色结果。通过传统巴氏染色，诊断结果分布如下：恶性 55 例，疑似恶性 60 例，非典型 45 例，无恶性证据 58 例。MARS1 IF 染色在恶性胆管狭窄中呈强阳性，但在无恶性证据的标本中则无阳性。MARS1 IF（93.6%、96.7%、98.7%、85.5%和 94.5%）和传统巴氏染色（73.2%、100%、100%、59.2%和 80.7%）的诊断参数（敏感性、特异性、阳性预测值、阴性预测值和准确性）差异有统计学意义（P<0.0001）。
MARS1 IF 染色的高敏感性和准确性可检测胆管狭窄患者的恶性肿瘤。需要进一步的前瞻性研究来验证我们的发现。（临床试验注册号：NCT03708445）。
