恶性胆道梗阻的诊断：ERCP、MRCP 和组织学的思考。

Diagnosis of malignant biliary obstruction: pondering over the ERCP, MRCP and histology.

机构信息

Advanced Regional Research Centre in Gastroenterology and Hepatology, Department of Internal Medicine II, Discipline of Gastroenterology and Hepatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania.

Centre for Modelling Biological Systems and Data Analysis, Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy Timisoara, Romania.

出版信息

J Int Med Res. 2022 Feb;50(2):3000605221076924. doi: 10.1177/03000605221076924.

DOI:10.1177/03000605221076924

PMID:35170356

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8855398/

Abstract

OBJECTIVE

To compare the diagnostic accuracy of endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance pancreatography (MRCP) and histological examination for malignant biliary obstruction.

METHODS

This retrospective study included patients admitted for biliary obstruction caused by biliary tree malignancy that underwent ERCP, MRCP and histological examination. Data were collected from the medical records. The primary endpoints were the area under the receiver operating characteristic (AUROC) curve value, sensitivity, specificity and overall diagnostic accuracy of the three procedures in terms of a final diagnosis of obstructive biliary malignancy; and the agreement between ERCP, MRCP and histological examination with the final diagnosis.

RESULTS

A total of 160 patients were included in the study (85 males, 53.1%; mean ± SD age, 69.31 ± 10.96 years). Considering the final diagnosis, the performance of MRCP, ERCP and histology in assessing biliary tumours produced AUROC values of 0.88 (95% confidence interval [CI] 0.75, 0.90), 0.94 (95% CI 0.85, 0.99) and 0.80 (95% CI 0.70, 0.82), respectively. ERCP presented higher sensitivity, overall diagnostic accuracy and agreement with the final diagnosis than MRCP and histological examination.

CONCLUSION

These current data suggest that invasive methods such as ERCP with biopsy remain more reliable than non-invasive methods.

摘要

目的

比较内镜逆行胰胆管造影术（ERCP）、磁共振胰胆管成像术（MRCP）和组织学检查对恶性胆道梗阻的诊断准确性。

方法

本回顾性研究纳入了因胆道恶性肿瘤导致胆道梗阻而行 ERCP、MRCP 和组织学检查的患者。从病历中收集数据。主要终点是三种方法在最终诊断为梗阻性胆道恶性肿瘤时的接收者操作特征（ROC）曲线下面积（AUROC）值、敏感度、特异度和总体诊断准确性；以及 ERCP、MRCP 和组织学检查与最终诊断的一致性。

结果

共有 160 例患者纳入研究（男性 85 例，53.1%；平均年龄±标准差为 69.31±10.96 岁）。考虑最终诊断，MRCP、ERCP 和组织学检查评估胆道肿瘤的表现产生的 AUROC 值分别为 0.88（95%置信区间 [CI] 0.75，0.90）、0.94（95% CI 0.85，0.99）和 0.80（95% CI 0.70，0.82）。ERCP 与 MRCP 和组织学检查相比，具有更高的敏感度、总体诊断准确性和与最终诊断的一致性。