Early diagnosis of pancreatobiliary duct malignancies by brush cytology and biopsy
Early diagnosis of pancreatobiliary duct malignancies by brush cytology and biopsy
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DOI：
10.1007/bf02893391
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发表时间：
2005-01-01
影响因子：
2.8
通讯作者：
Pap, A
中科院分区：
文献类型：
--
作者：
Elek, G;Gyökeres, T;Pap, A
我们对113例胆道或Wirsung管狭窄患者进行了125例术前导管内取样（刷洗和活检）评估。103个狭窄可以通过手术标本的组织学、尸检或患者的临床过程来确定。术前诊断效果与肿瘤部位有关（壶腹和乳头旁肿瘤最佳），但细胞学敏感性、绝对敏感性、特异性、阳性预测值和阴性预测值、诊断准确率的平均定量指标分别为53%、20%、100%、100%、25%、59%。活检的相同值分别为43%、34%、100%、100%、36%和56%。在同时进行细胞学检查和活检后，这些数字有所改善。在阴性、不确定和发育不良（27%）的病例中，与内窥镜医师密切合作是必要的。重复取样使结果提高了8%。在26例术前假阴性病例中，抽样错误、技术错误和解释错误分别占84%、4%和12%。细胞学刷检假阴性病例中恶性病例4例。考虑到最新的标准-原发性和继发性恶性特征，胰腺上皮内瘤变（PanINs）等-重新分类标本，提高了诊断效率。
Two hundred and five preoperative intraductal samplings (brushing and biopsy) were evaluated from 113 patients with biliary or Wirsung duct strictures. One hundred and three strictures could be specified by histology of the operative specimens, autopsy, or by the patients' clinical course. Preoperative diagnostic efficacy depended on the tumor location ( it was the best for ampullary and parapapillary tumors), but the average quantitative indices for sensitivity, absolute sensitivity, specificity, positive and negative predictive values, diagnostic accuracy of cytology were 53%, 20%, 100%, 100%, 25%, 59%, respectively. The same values for biopsy were 43%, 34%, 100%, 100%, 36% and 56%. These figures improved after simultaneous cytology and biopsy. Close cooperation with the endoscopist was necessary in cases of negative, inconclusive and dysplastic (27%) samples. Repetition of sampling improved the results by 8%. Among the 26 preoperative false negative cases, sampling, technical- and interpretative errors occurred in 84%, 4% and 12%, respectively. Revision of samples revealed 4 malignant cases among the false negative cytologic brushings. Reclassification of specimens considering the latest criteria - primary and secondary malignant features, pancreatic intraepithelial neoplasia (PanINs), etc. - resulted in improvement of the diagnostic efficiency.