Improved classification of indeterminate biliary strictures by probe-based confocal laser endomicroscopy using the Paris Criteria following biliary stenting.
Improved classification of indeterminate biliary strictures by probe-based confocal laser endomicroscopy using the Paris Criteria following biliary stenting.
复制标题
胆管支架置入术后使用巴黎标准，通过基于探针的共聚焦激光内窥镜改进了不确定胆管狭窄的分类。
DOI：
10.1111/jgh.13782
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发表时间：
2017
影响因子：
4.1
通讯作者：
Sharma,Ashish
中科院分区：
文献类型：
--
作者：
Taunk,Pushpak;Singh,Satish;Lichtenstein,David;Joshi,Virendra;Gold,Jason;Sharma,Ashish
背景和目的使用迈阿密标准的基于探针的共聚焦激光显微内镜（pCLE）改善了不确定性胆管狭窄的分类。然而，先前的胆道支架植入术可能导致其被错误分类为恶性狭窄。增加了炎症标准以形成巴黎分类，以防止这种错误分类并减少假阳性。本研究的目的是评估，如果巴黎分类是更准确的比迈阿密分类在分类不确定的胆管狭窄后biliary stenting.MethodsThis是一项回顾性观察研究，涉及21例不确定的胆管狭窄，其中27 pCLE视频序列获得（20良性和恶性）。既往接受过和未接受过胆道支架植入术的患者均接受了pCLE。两名研究者使用迈阿密和巴黎分类法将狭窄分为恶性或良性。将内镜逆行引导pCLE的诊断准确性、敏感性（Se）和特异性（Sp）与最终组织病理学进行比较。结果在未行胆道支架术的患者中，迈阿密标准的Se为88%，Sp为75%，阳性预测值（PPV）为64%，阴性预测值（NPV）为92%，准确性为79%，而巴黎分类的Se为63%，Sp为88%，PPV 71%，NPV 82%，准确率79%。在既往接受过胆道支架植入术的患者中，迈阿密标准的Se为88%，Sp为36%，PPV为23%，NPV为93%，准确性为45%，而巴黎分类的Se为63%，Sp为73%，PPV为31%，NPV为91%，准确性为71%。结论巴黎分类提高了支架术后胆管狭窄分类的特异性和准确性，降低了良性狭窄误诊为恶性狭窄的发生率。
Background and AimsProbe‐based confocal laser endomicroscopy (pCLE) using the Miami Criteria has improved classification of indeterminate biliary strictures. However, previous biliary stenting may result in their misclassification as malignant strictures. Inflammatory criteria were added to form the Paris Classification to prevent this misclassification and reduce false positives. The aim of this study was to assess if the Paris Classification was more accurate than the Miami Classification in classifying indeterminate biliary strictures after biliary stenting.MethodsThis was a retrospective observational study involving 21 patients with indeterminate biliary strictures from whom 27 pCLE video sequences were obtained (20 benign and seven malignant). Patients with and without prior biliary stenting underwent pCLE. Two investigators classified the strictures as malignant or benign using the Miami and Paris Classifications. Diagnostic accuracy, sensitivity (Se), and specificity (Sp) of endoscopic retrograde‐guided pCLE were compared with final histopathology.ResultsIn those without biliary stenting, the Miami Criteria resulted in Se 88%, Sp 75%, positive predictive value (PPV) 64%, negative predictive value (NPV) 92%, and accuracy 79%, while the Paris Classification resulted in Se 63%, Sp 88%, PPV 71%, NPV 82%, and accuracy 79%. In those with prior biliary stenting, the Miami Criteria resulted in Se 88%, Sp 36%, PPV 23%, NPV 93%, and accuracy 45%, while the Paris Classification resulted in Se 63%, Sp 73%, PPV 31%, NPV 91%, and accuracy 71%. The kappa statistic was 0.56.ConclusionThe Paris Classification improved specificity and accuracy of biliary stricture classification in those who had been previously stented and decreased the rate of misclassification of benign strictures as malignant.