Nur Abdulsemed M, Salim Misbah, Boerner Scott, Li Suqing, Law Cindy C Y, Edwards Leanne, Ryan Kaitlin, James Paul D
Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.
Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, Canada.
J Can Assoc Gastroenterol. 2022 May 5;5(5):234-239. doi: 10.1093/jcag/gwac011. eCollection 2022 Oct.
Endoscopic retrograde cholangiopancreatography (ERCP) brush cytology is used frequently for sampling indeterminate biliary strictures. Studies have demonstrated that the diagnostic yield of brush cytology for malignant strictures is estimated to be 6%-70%. With improved diagnostic tools, sampling techniques and specimen processing, the yield of ERCP brush cytology may be higher. This study aimed to assess the yield of brush cytology and determine factors associated with a positive diagnosis.
This was a cohort study of patients who underwent ERCP brush cytology from October 2017 to May 2020. Patient demographics, clinical, procedural and pathological data were collected using chart review. Sampling data were captured up to 3 months post-index ERCP to capture repeat brushings, biopsies or surgical resections. Outcomes included the diagnostic yield, true/false positive values and true/false negative values of malignancy detection using ERCP brush cytology.
A total of 126 patients underwent a brush cytology, 58% were male and 79% had a stricture in the extrahepatic region. Ninety-three patients were diagnosed with a malignancy, of which 78 had positive brush cytology results and 15 had a negative brush cytology result. The diagnostic yield, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 84%, 83%, 97%, 99%, 68% and 87% respectively.
ERCP brush cytology performed using updated sampling technique is associated with high diagnostic yield. This allows for earlier malignancy diagnosis, timely treatment and decreased need for further investigation.
内镜逆行胰胆管造影术（ERCP）刷检细胞学检查常用于对不确定的胆管狭窄进行取样。研究表明，刷检细胞学检查对恶性狭窄的诊断率估计为6% - 70%。随着诊断工具、取样技术和标本处理的改进，ERCP刷检细胞学检查的诊断率可能会更高。本研究旨在评估刷检细胞学检查的诊断率，并确定与阳性诊断相关的因素。
这是一项对2017年10月至2020年5月接受ERCP刷检细胞学检查的患者进行的队列研究。通过查阅病历收集患者的人口统计学、临床、操作和病理数据。收集索引ERCP后长达3个月的取样数据，以获取重复刷检、活检或手术切除情况。结果包括使用ERCP刷检细胞学检查进行恶性肿瘤检测的诊断率、真/假阳性值和真/假阴性值。
共有126例患者接受了刷检细胞学检查，其中58%为男性，79%的患者肝外区域有狭窄。93例患者被诊断为恶性肿瘤，其中78例刷检细胞学检查结果为阳性，15例刷检细胞学检查结果为阴性。诊断率、敏感性、特异性分别为84%、83%、97%，阳性预测值、阴性预测值和准确性分别为99%、68%和87%。
采用更新的取样技术进行ERCP刷检细胞学检查具有较高的诊断率。这有助于早期诊断恶性肿瘤、及时治疗并减少进一步检查的需求。
