Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea.
Dig Dis Sci. 2022 Jul;67(7):3284-3297. doi: 10.1007/s10620-021-07138-4. Epub 2021 Jul 14.
Endoscopic sampling is essential for tissue diagnosis of cholangiocarcinoma (CCA). To evaluate and compare the diagnostic sensitivities of endoscopic retrograde cholangiopancreatography-guided brush cytology biopsy, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with CCA. A comprehensive literature search through multiple databases was conducted for articles published between January 1995 and August 2020. The pooled rates of sensitivity for the diagnosis of CCA and of adverse events were compared among brushing, biopsy, brushing & biopsy, and EUS-FNA. In total, 1123 patients with CCA (32 studies), 719 patients (20 studies), 358 patients (13 studies), and 422 patients (17 studies) were tested by brushing, biopsy, brushing & biopsy, and EUS-FNA, respectively. The pooled diagnostic sensitivity was 56.0% (95% confidence interval (CI) 48.8-63.1%, I = 83.0%) with brushing, 67.0% (95% CI 60.2-73.5%, I = 72.5%) with biopsy, 70.7% (95% CI 64.1-76.8%, I = 42.7%) with brushing & biopsy, and 73.6% (95% CI 64.7-81.5%, I = 74.7%) with EUS-FNA. The diagnostic sensitivity was significantly lower for brushing than for biopsy, brushing & biopsy, or EUS-FNA. No significant difference was noted in diagnostic sensitivities among biopsy, brushing & biopsy, and EUS-FNA. Adverse events were comparable between the groups. Intraductal biopsy, brushing & biopsy, and EUS-FNA had comparable efficacy and safety for the diagnosis of CCA. Brushing was the least sensitive diagnostic tool compared with intraductal biopsy or EUS-FNA. Given the modest diagnostic sensitivities of intraductal biopsy and EUS-FNA in the diagnosis of CCA, further studies for complementing these techniques with biomarkers may be needed.
内镜下取样对胆管癌（CCA）的组织诊断至关重要。本研究旨在评估和比较内镜逆行胰胆管造影（ERCP）引导下刷检细胞学活检和内镜超声引导下细针抽吸（EUS-FNA）对 CCA 患者的诊断敏感性。通过多个数据库对 1995 年 1 月至 2020 年 8 月期间发表的文章进行了全面的文献检索。比较了刷检、活检、刷检+活检和 EUS-FNA 对 CCA 诊断的敏感性和不良事件发生率。共纳入 1123 例 CCA 患者（32 项研究）、719 例患者（20 项研究）、358 例患者（13 项研究）和 422 例患者（17 项研究）分别接受刷检、活检、刷检+活检和 EUS-FNA 检查。刷检的汇总诊断敏感性为 56.0%（95%置信区间 48.8-63.1%，I=83.0%），活检为 67.0%（95%置信区间 60.2-73.5%，I=72.5%），刷检+活检为 70.7%（95%置信区间 64.1-76.8%，I=42.7%），EUS-FNA 为 73.6%（95%置信区间 64.7-81.5%，I=74.7%）。刷检的诊断敏感性明显低于活检、刷检+活检和 EUS-FNA。活检、刷检+活检和 EUS-FNA 的诊断敏感性无显著差异。各组间不良事件发生率无差异。胆管内活检、刷检+活检和 EUS-FNA 对 CCA 的诊断具有相似的有效性和安全性。与胆管内活检或 EUS-FNA 相比，刷检是最不敏感的诊断工具。鉴于胆管内活检和 EUS-FNA 诊断 CCA 的敏感性不高，可能需要进一步研究通过生物标志物来补充这些技术。
