So Hoonsub, Jang Sung Ill, Ko Sung Woo, Yoon Seung Bae, Lee Young Sub, Bang SungJo, Kim Misung, Choi Hye-Jeong
Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea.
Department of Internal Medicine, Institute of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea.
World J Clin Cases. 2025 May 26;13(15):99212. doi: 10.12998/wjcc.v13.i15.99212.
Brush cytology is the most commonly used technique for tissue acquisition during endoscopic retrograde cholangiopancreatography for the evaluation of biliary strictures. Nonetheless, brush cytology is limited by its low sensitivity due to insufficient cellular yield.
To evaluate the impact of the sheath-rinse technique on improving the cellularity yield.
A total of 112 patients with suspected malignant biliary strictures were enrolled at two tertiary centers in South Korea. The sample cellularity and diagnostic accuracy of brush-wash and sheath-rinse specimens were compared.
A significantly increased number of total cell clusters per representative 20 × field was recorded in the sheath-rinse compared with the brush-wash specimens (median: 12 3, < 0.001). This trend persisted when large (> 50 cells) clusters (median: 8 3, < 0.001), medium (6-49 cells) (median: 7 3, < 0.001), and small (2-5 cells) clusters (median: 9 3, < 0.001) were evaluated. Diagnostic accuracy and sensitivity for differentiating malignancy were superior with sheath-rinsing than with the brush-wash method (72.3% 62.5%, < 0.001 and 69.9% 59.2%, < 0.001, respectively).
Incorporating sheath-rinse specimens significantly improved the yield and diagnostic accuracy of biliary brush cytology. Sheath-rinsing should be integrated into routine clinical practice to improve diagnostic performance for biliary strictures.
在经内镜逆行胰胆管造影术评估胆管狭窄时，刷检细胞学是最常用的组织获取技术。然而，由于细胞产量不足，刷检细胞学的敏感性较低。
评估鞘管冲洗技术对提高细胞产量的影响。
韩国两家三级中心共纳入112例疑似恶性胆管狭窄患者。比较刷洗和鞘管冲洗标本的样本细胞量及诊断准确性。
与刷洗标本相比，鞘管冲洗标本中每个代表性20×视野的总细胞簇数量显著增加（中位数：12对3，<0.001）。当评估大（>50个细胞）簇（中位数：8对3，<0.001）、中（6 - 49个细胞）簇（中位数：7对3，<0.001）和小（2 - 5个细胞）簇（中位数：9对3，<0.001）时，这一趋势持续存在。鞘管冲洗在鉴别恶性肿瘤方面的诊断准确性和敏感性优于刷洗法（分别为72.3%对62.5%，<0.001和69.9%对59.2%，<0.001）。
纳入鞘管冲洗标本显著提高了胆管刷检细胞学的产量和诊断准确性。鞘管冲洗应纳入常规临床实践，以提高胆管狭窄的诊断性能。
