Cohen M B, Wittchow R J, Johlin F C, Bottles K, Raab S S
Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, USA.
Mod Pathol. 1995 Jun;8(5):498-502.
Malignant strictures of the extrahepatic biliary tract are difficult to discern from benign strictures solely by clinical and/or radiographic findings. Endoscopic retrograde wire-guided brushings of strictures have proven to be useful in evaluating such lesions. Because the reported sensitivity of diagnosing adenocarcinoma of the extrahepatic biliary tract by this technique has varied considerably (44 to 100%), we undertook a retrospective study to determine if the diagnostic accuracy could be increased by identifying key cytologic features by reviewing a series of 90 biliary tract brushings from 80 patients. The cytologic diagnosis was confirmed either by additional pathologic material and/or clinical follow-up. Utilizing a multiple logistic regression analysis, three key cytologic features were identified that were useful in separating benign from malignant strictures; these features included: nuclear molding, chromatin clumping, and increased nuclear-cytoplasmic ratio. The presence of two of these three features resulted in a sensitivity of 83%; the corresponding specificity was 98%. The use of these key features should aid the cytologist in better recognizing malignant cells in biliary tract brushings.
仅通过临床和/或影像学检查结果，很难将肝外胆道恶性狭窄与良性狭窄区分开来。内镜逆行导丝引导下对狭窄部位进行刷检已被证明在评估此类病变中很有用。由于通过该技术诊断肝外胆道腺癌的报道敏感性差异很大（44%至100%），我们进行了一项回顾性研究，通过回顾80例患者的90份胆道刷检样本，确定能否通过识别关键细胞学特征来提高诊断准确性。细胞学诊断通过额外的病理材料和/或临床随访得以证实。利用多元逻辑回归分析，确定了三个有助于区分良性和恶性狭窄的关键细胞学特征；这些特征包括：核塑形、染色质凝聚和核质比增加。这三个特征中出现两个时，敏感性为83%；相应的特异性为98%。使用这些关键特征应有助于细胞学家更好地识别胆道刷检中的恶性细胞。
