Lieb Kayla R, Williams Zachary E, Sayles Harlan, Zaman Muizz, Dhir Mashaal
Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA.
Ann Surg Oncol. 2025 Apr 24. doi: 10.1245/s10434-025-17292-y.
Malignancy remains one of the major differentials for bile duct strictures (BDS). Endoscopic sampling of the BDS provides low and variable sensitivity, often reporting "atypical" or "suspicious" cytology results in accordance with Papanicolaou criteria. We sought to perform a systematic review investigating the risk of malignancy for initially indeterminate cytology to aid in preoperative patient counseling.
A comprehensive search of databases including Scopus, EMBASE, and PubMed, was performed between each database's inception and 8 July 2024. Observational studies confirming malignancy rates in patients with atypical and/or suspicious bile duct cytology upon initial endoscopic brush cytology were included. Two reviewers independently screened articles and extracted data. Of 4159 articles initially identified, 144 were examined in full-text review and 46 were deemed eligible for inclusion.
Of 8458 total samples, 2826 (33.3%) samples had indeterminate brush cytology, consisting of either atypical (n = 1902) or suspicious (n = 924) brushings. Malignancy risk in samples with atypical and suspicious brush cytology was 50.4% and 80.2%, respectively. Suspicious cytology was associated with a relative risk of 1.59 for malignancy relative to atypical cytology. There was a 60.1% risk of malignancy among all samples with indeterminate brush cytology.
Our study provides pooled estimates of risk of malignancy in patients with bile duct strictures and indeterminate cytology. This is one of the first meta-analyses on the topic. Our findings can be used by physicians for preoperative counseling of patients being worked up surgically for biliary strictures with indeterminate cytology.
恶性肿瘤仍然是胆管狭窄（BDS）的主要鉴别诊断之一。对BDS进行内镜取样的敏感性较低且变化不定，根据巴氏标准，其细胞学结果常报告为“非典型”或“可疑”。我们旨在进行一项系统评价，以研究最初细胞学结果不确定时的恶性肿瘤风险，从而辅助术前患者咨询。
在每个数据库建立至2024年7月8日期间，对包括Scopus、EMBASE和PubMed在内的数据库进行了全面检索。纳入观察性研究，这些研究证实了初次内镜刷检细胞学结果为非典型和/或可疑胆管细胞学的患者的恶性肿瘤发生率。两名审阅者独立筛选文章并提取数据。在最初识别出的4159篇文章中，有144篇进行了全文审阅，46篇被认为符合纳入标准。
在总共8458个样本中，2826个（33.3%）样本的刷检细胞学结果不确定，包括非典型（n = 1902）或可疑（n = 924）刷检。非典型和可疑刷检细胞学样本的恶性肿瘤风险分别为50.4%和80.2%。相对于非典型细胞学，可疑细胞学的恶性肿瘤相对风险为1.59。所有刷检细胞学结果不确定的样本中，恶性肿瘤风险为60.1%。
我们的研究提供了胆管狭窄且细胞学结果不确定患者恶性肿瘤风险的汇总估计。这是该主题的首批荟萃分析之一。我们的研究结果可供医生用于对因胆管狭窄接受手术治疗且细胞学结果不确定的患者进行术前咨询。
