Lee J G, Leung J W, Baillie J, Layfield L J, Cotton P B
Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA.
Am J Gastroenterol. 1995 May;90(5):722-6.
To determine the efficacy of endoscopic bile duct brush cytology for diagnosis of pancreaticobiliary malignancies and to provide guidelines for interpretation of dysplastic cytology.
Consecutive endoscopic bile duct brush cytology specimens were classified by an independent cytopathologist as benign, low- or high-grade dysplasia, or cancer. A final diagnosis was established in a blinded fashion by histopathology, radiographic evidence of metastatic disease, or independent clinical follow-up. Sensitivity and specificity were adjusted for dysplastic cytology, and likelihood ratios were determined for each diagnosis and used for calculation of posttest probability of malignancy.
Dysplasia was found in 23% of 168 consecutive bile duct brushings performed in 149 patients. Sensitivity of brush cytology was 37% and specificity 100%; its likelihood ratio for malignancy ranged from 3.4 for high-grade dysplasia, to 1.1 for low-grade dysplasia, to 0.6 for benign. For a patient with a 50% pretest probability of malignancy, finding of high-grade dysplasia changed the posttest probability to 77%, low-grade dysplasia to 52%, and benign to 38%.
Cytological dysplasia occurs frequently, with high-grade dysplasia being strongly suggestive of malignancy. Presented likelihood ratios can be used to calculate the posttest probability of malignancy for any diagnosis.
确定内镜下胆管刷检细胞学检查对胰胆恶性肿瘤的诊断效能，并为发育异常细胞学的解读提供指导原则。
由一名独立的细胞病理学家将连续的内镜下胆管刷检标本分类为良性、低级别或高级别发育异常或癌症。通过组织病理学、转移性疾病的影像学证据或独立的临床随访以盲法方式确立最终诊断。针对发育异常细胞学对敏感性和特异性进行调整，并确定每种诊断的似然比，用于计算恶性肿瘤的检验后概率。
在149例患者进行的168次连续胆管刷检中，23%发现有发育异常。刷检细胞学的敏感性为37%，特异性为100%；其恶性肿瘤的似然比范围从高级别发育异常的3.4到低级别发育异常的1.1，再到良性的0.6。对于一名恶性肿瘤检验前概率为50%的患者，发现高级别发育异常将检验后概率变为77%，低级别发育异常变为52%，良性变为38%。
细胞学发育异常经常发生，高级别发育异常强烈提示恶性肿瘤。所呈现的似然比可用于计算任何诊断的恶性肿瘤检验后概率。
