Utility of pancreatic duct brushing for diagnosis of pancreatic carcinoma
Utility of pancreatic duct brushing for diagnosis of pancreatic carcinoma
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DOI：
10.1007/s00535-007-2071-7
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发表时间：
2007-08-01
影响因子：
6.3
通讯作者：
Kuriyama, Shigeki
中科院分区：
文献类型：
--
作者：
Uchida, Naohito;Kamada, Hideki;Kuriyama, Shigeki
背景本研究的目的是评估胰管刷检对胰腺癌诊断的有效性。方法.对58例因主胰管狭窄而怀疑胰腺恶性肿瘤的患者进行了刷检细胞学检查，并经内镜逆行胰胆管造影证实。38例患者经手术或临床过程最终诊断为胰腺癌，其余20例患者为慢性胰腺炎。探讨刷检细胞学对胰腺癌的诊断价值。当病变为恶性时，我们将胰管刷检失败解释为假阴性。结果在58例患者中，48例（82.8%）成功进行了刷牙，并获得了令人满意的标本。38例胰腺癌患者中25例刷检细胞学阳性（敏感性65.8%），非恶性肿瘤患者全部阴性（特异性100%）。总体准确率为76.4%。2001年至2005年间，刷子来回运动的次数增加到30多次。敏感性从1997 - 2000年的43.8%提高到2001 - 2005年的81.8%（P <0.05）。随着时间的推移，通过提高操纵导丝的技能提高了刷拭成功率，通过增加刷的来回运动增加了涂片在载玻片上的细胞数量，这可能是这种改善的原因。此外，2001 - 2005年的敏感性为85.7%，如果排除与胰腺癌刷牙失败。除2例中度急性胰腺炎患者外，未发生严重并发症。结论.尽管还需要对大量患者进行进一步研究，但我们的结果表明，随着近年来刷检技术的改进，胰管刷检是一种有用且安全的方法，可用于胰腺恶性疾病与良性疾病的鉴别诊断。
Background. The aim of this study was to evaluate the usefulness of pancreatic duct brushing for diagnosis of pancreatic carcinoma. Methods. Brush cytology was attempted in 58 patients suspected of having pancreatic malignancy because of stricture of the main pancreatic duct, confirmed by endoscopic retrograde cholangiopancreatography. Thirty-eight patients were finally diagnosed by an operation or the clinical course as having pancreatic carcinoma, and the remaining 20 patients as having chronic pancreatitis. The usefulness of brush cytology for diagnosis of pancreatic carcinoma was estimated. We interpreted failures of pancreatic duct brushing to be false negatives when the lesion was malignant. Results. In 48 of 58 patients (82.8%), brushing was successfully performed and satisfactory specimens were obtained. Brush cytology was positive in 25 of 38 patients with pancreatic carcinoma (sensitivity 65.8%) and negative in all patients without malignancy (specificity 100%). Overall accuracy was 76.4%. During 2001-2005, the number of back-and-forth motions of the brush was increased to more than 30 times. The sensitivity significantly improved from 43.8% in 1997-2000 to 81.8% in 2001-2005 (P < 0.05). The increased success rate of brushing by improvement of skill in manipulating the guidewire and increased number of cells smeared on glass slides by increased back-and-forth motion of the brush may account for this improvement over time. Moreover, the sensitivity in 2001-2005 was 85.7% if failures of brushing with pancreatic carcinoma are excluded. No major complications occurred, except for two patients with a moderate grade of acute pancreatitis. Conclusions. Although further studies with a large number of patients are needed, our results suggest that with recent improvements of the brushing technique, pancreatic duct brushing is a useful and safe method for the differential diagnosis of malignancy from benign diseases of the pancreas.