VALUE OF EXFOLIATIVE CYTOLOGY FOR INVESTIGATING BILE-DUCT STRICTURES
VALUE OF EXFOLIATIVE CYTOLOGY FOR INVESTIGATING BILE-DUCT STRICTURES
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DOI：
10.1136/gut.33.10.1408
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发表时间：
1992-10-01
期刊：
影响因子：
24.5
通讯作者：
HOBBS, K
中科院分区：
文献类型：
--
作者：
DAVIDSON, B;VARSAMIDAKIS, N;HOBBS, K
胆道狭窄的原因可能难以通过放射学确定。对 1984 年 1 月至 1989 年 12 月期间因胆道狭窄到肝胆科就诊的 62 名患者（中位年龄 65 岁，范围 30-94 岁）进行了剥脱性胆管细胞学检查。42 名患者在内镜逆行胰胆管造影 (ERCP) 期间采集了胆汁样本，14 名患者进行了经皮胆管造影，6 名患者均进行了经皮胆管造影。狭窄部位为胆管上三分之一（n=27），10%（n=6）为中三分之一，47%（n=29）为下三分之一。在 47 例放射学表现出恶性狭窄的患者中，22 例 (47%) 通过计算机断层扫描引导下、内窥镜检查、手术或尸检时的活检进行了组织学证实。 47 名患者中有 14 名细胞学检查呈阳性（30%）。 7 名患者仅通过细胞学检查就确定存在恶性肿瘤（15%），另外 7 名患者的细胞学检查呈阳性，并通过组织学进行了证实。因此，在组织活检中加入细胞学检查，47 名患者中有 29 名 (62%) 被确诊为恶性肿瘤。随后显示患有良性疾病的 15 名患者均未出现细胞学阳性。该技术的敏感性为 30%，特异性为 100%。脱落细胞学样本易于获取，结果具有高度特异性，应成为胆管狭窄检查的常规部分。
The cause of a biliary tract stricture may be difficult to determine radiologically. Exfoliative biliary cytology was evaluated in 62 patients (median age 65 years, range 30-94) with biliary tract strictures presenting to the Hepatobiliary Unit between January 1984 and December 1989. Bile samples were taken during endoscopic retrograde cholangiopancreatography (ERCP) in 42 patients, percutaneous cholangiography in 14, and both in six. The site of stricturing was upper third of the bile duct in 43% (n=27), middle third in 10% (n=six), and lower third in 47% (n=29). Of the 47 patients with radiological appearances of a malignant stricture, 22 (47%) had histological confirmation by biopsy either under computed tomography guidance, at endoscopy, at operation, or at necropsy. Fourteen of the 47 patients had positive cytology (30%). In seven patients cytology alone established the presence of malignancy (15%) and in the other seven positive cytology was confirmed by histology. The addition of cytology to tissue biopsy therefore allowed malignancy to be confirmed in 29 of the 47 patients (62%). None of the 15 patients subsequently shown to have benign disease had positive cytology. Sensitivity of the technique was 30% and specificity 100%. Samples for exfoliative cytology are simple to obtain, the results are highly specific and should be a routine part of the investigation of biliary strictures.