Gros Beatriz, Alañón Martínez Paloma Elma, Orti Cuerva Marina, Aparicio-Serrano Ana, Gallego Jiménez Elma, Santos Lucio Ana, Pleguezuelo Navarro María, Hervás Molina Antonio, Serrano Ruiz Francisco Javier
Gastroenterology, Hospital Universitario Reina Sofía, Spain.
Gastroenterology, Hospital Universitario Reina Sofía.
Rev Esp Enferm Dig. 2025 Aug;117(8):447-454. doi: 10.17235/reed.2025.11158/2025.
biliary brushing cytology during endoscopic retrograde cholangiopancreatography (ERCP) was used to assess the nature of a biliary stricture. Its low sensitivity challenges the exclusion of malignancy through this technique. The aim of this study was to evaluate the diagnostic yield of brush cytology in biliary strictures and to identify predictive factors associated with a positive diagnosis of malignancy.
an observational retrospective study was performed in a tertiary center. All adult patients undergoing a biliary brushing during ERPC from 2016 to 2022 were included. Logistic regression analyses were performed to identify predictive factors for positive brush cytology.
a total of 5,309 patients underwent ERCP within the evaluated period. Out of these, biliary brushing was performed in 518 patients, including 568 cytology samples; 57.7 % (299) were male, with a median of 74 (64-84) years of age. Within the cohort, 24 % (126) had benign strictures and 76 % (392) had malignancy, of which the most common etiologies were pancreatic cancer 42.5 % (220/518), followed by cholangiocarcinoma 22.6 % (117/518). The sensitivity, specificity, positive predictive value, and negative predictive value were 48 %, 98 %, 98 % and 37 %, respectively. Sensitivity was 45 % and 52 % in pancreatic adenocarcinoma and cholangiocarcinoma, respectively. Older age (OR 1.02, 95 % CI: 1.01-1.03, p = 0.01) and higher bilirubin levels (OR 1.05, 95 % CI: 1.03-1.08, p < 0.001) were independent predictors for brush cytology positivity. The post-ERCP complication rate was 9.7 % (45/518).
biliary brushing cytology during ERCP is a safe procedure with a low sensitivity and high specificity. Older age and higher bilirubin levels are associated with positive biliary cytology.
内镜逆行胰胆管造影术（ERCP）期间的胆管刷检细胞学用于评估胆管狭窄的性质。其低敏感性对通过该技术排除恶性肿瘤提出了挑战。本研究的目的是评估胆管狭窄中刷检细胞学的诊断率，并确定与恶性肿瘤阳性诊断相关的预测因素。
在一家三级中心进行了一项观察性回顾性研究。纳入了2016年至2022年期间在ERPC期间接受胆管刷检的所有成年患者。进行逻辑回归分析以确定刷检细胞学阳性的预测因素。
在评估期间共有5309例患者接受了ERCP。其中，518例患者进行了胆管刷检，包括568份细胞学样本；57.7%（299例）为男性，中位年龄为74岁（64 - 84岁）。在该队列中，24%（126例）患有良性狭窄，76%（392例）患有恶性肿瘤，其中最常见的病因是胰腺癌42.5%（220/518），其次是胆管癌22.6%（117/518）。敏感性、特异性、阳性预测值和阴性预测值分别为48%、98%、98%和37%。胰腺癌和胆管癌的敏感性分别为45%和52%。年龄较大（OR 1.02，95%CI：1.01 - 1.03，p = 0.01）和胆红素水平较高（OR 1.05，95%CI：1.03 - 1.08，p < 0.001）是刷检细胞学阳性的独立预测因素。ERCP后并发症发生率为9.7%（45/518）。
ERCP期间的胆管刷检细胞学是一种安全的检查方法，敏感性低但特异性高。年龄较大和胆红素水平较高与胆管细胞学阳性相关。
