Pelsang R E, Johlin F C
Department of Radiology, University of Iowa College of Medicine, Iowa City 52242, USA.
Abdom Imaging. 1997 May-Jun;22(3):307-10. doi: 10.1007/s002619900195.
Treatment of malignant pancreatic and/or biliary strictures requires tissue diagnosis. Since cytologic brushings at endoscopic retrograde cholangiopancreatography (ERCP) of these strictures has a poor sensitivity for malignancy (30-83%) (see ME Ryan. Gastrointestinal Endoscopy 1991;37(2):139-143; and MB Cohen, Wittchow RJ, Johlin FC, et al. Mod Pathol 1995;8:498-502), tissue diagnosis must be obtained by another route. We report our experience of percutaneous biopsy of malignant pancreatic and/or biliary strictures even when no radiographic mass is present.
At ERCP, five patients demonstrated pancreatic and/or biliary duct strictures, had atypical cytological brushings, and had their strictures stented. No mass to account for the strictures could be identified on CT. These five patients underwent percutaneous biopsy of the persistent material by CT within 10 days of the ERCP.
Two patients had adenocarcinoma of the pancreas. One patient had malignant lymphoma and another had cholangiocarcinoma. One patient had inflammatory cells and was followed.
If the diagnosis of malignancy cannot be made at the time of the ERCP sampling, then our experience suggests that a percutaneous biopsy should be performed even if a mass is not present using the stent as a target.
恶性胰腺和/或胆管狭窄的治疗需要组织诊断。由于在内镜逆行胰胆管造影术（ERCP）时对这些狭窄进行细胞学刷检对恶性肿瘤的敏感性较差（30 - 83%）（见ME Ryan。《胃肠内镜学》1991年；37(2):139 - 143；以及MB Cohen、Wittchow RJ、Johlin FC等人。《现代病理学》1995年；8:498 - 502），必须通过其他途径获得组织诊断。我们报告了即使在没有影像学肿块的情况下，对恶性胰腺和/或胆管狭窄进行经皮活检的经验。
在ERCP检查时，5例患者表现出胰腺和/或胆管狭窄，细胞学刷检结果不典型，且对其狭窄部位进行了支架置入。CT检查未发现可解释狭窄的肿块。这5例患者在ERCP检查后10天内通过CT引导对残留物质进行了经皮活检。
2例患者患有胰腺癌。1例患者患有恶性淋巴瘤，另1例患有胆管癌。1例患者有炎性细胞，对其进行了随访。
如果在ERCP采样时无法做出恶性肿瘤的诊断，那么我们的经验表明，即使没有肿块，也应以支架为靶点进行经皮活检。
