McGuire D E, Venu R P, Brown R D, Etzkorn K P, Glaws W R, Abu-Hammour A
Section of Digestive and Liver Diseases, University of Illinois at Chicago 60612-7323, USA.
Gastrointest Endosc. 1996 Sep;44(3):300-4. doi: 10.1016/s0016-5107(96)70168-2.
Despite recent advances in cytology brush design, yield of endoscopic brush cytology in suspected pancreatic carcinoma remains low.
We prospectively evaluated 32 such patients by ERCP to analyze differences in yield based on anatomic location of the pancreatic stricture, and the role of concurrent biliary stricture brush cytology, in improving the overall yield. Endoscopic brush cytology was performed on all strictures following ERCP. A final diagnosis of pancreatic carcinoma was confirmed in all patients.
Twenty-three of the 32 patients had positive cytology for pancreatic malignancy (71.9%). Eight patients had positive brushings from biliary strictures alone (25%) and 15 had positive brushings obtained from pancreatic strictures (46.9%). The yield varied widely depending on the anatomic location of the stricture; ampullary, genu, and tail regions had low rates of positive cytology, in part due to technical factors and brush design (1 of 8, 2 of 6, and 1 of 4, respectively). Strictures of the head and body yielded high rates of positive cytology (7 of 8 and 4 of 6, respectively).
The yield of endopancreatic brush cytology is related to the location of malignancy, with overall yield enhanced by concurrent brushing of bile duct strictures.
尽管近年来细胞学刷设计有所进步，但内镜下刷检细胞学诊断疑似胰腺癌的阳性率仍然较低。
我们对32例此类患者进行了前瞻性ERCP评估，以分析基于胰腺狭窄解剖位置的阳性率差异，以及同时进行胆管狭窄刷检细胞学检查在提高总体阳性率中的作用。ERCP后对所有狭窄部位进行内镜刷检细胞学检查。所有患者均确诊为胰腺癌。
32例患者中有23例胰腺恶性肿瘤细胞学检查呈阳性（71.9%）。8例患者仅胆管狭窄刷检呈阳性（25%），15例患者胰腺狭窄刷检呈阳性（46.9%）。根据狭窄的解剖位置，阳性率差异很大；壶腹、膝部和尾部区域的阳性细胞学检查率较低，部分原因是技术因素和刷的设计（分别为8例中的1例、6例中的2例和4例中的1例）。胰头和胰体部狭窄的阳性细胞学检查率较高（分别为8例中的7例和6例中的4例）。
胰腺内刷检细胞学检查的阳性率与恶性肿瘤的位置有关，同时刷检胆管狭窄可提高总体阳性率。
