Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis.
Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis.
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DOI：
10.1016/j.gie.2014.09.017
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发表时间：
2015-01
影响因子：
7.7
通讯作者：
Parsi MA
中科院分区：
文献类型：
--
作者：
Navaneethan U;Njei B;Lourdusamy V;Konjeti R;Vargo JJ;Parsi MA
不明原因胆管狭窄的评估通常涉及组织或细胞的收集和分析。ERCP期间常规进行刷检和胆管内活检以评估恶性胆管狭窄的方法，其敏感性相对较低。目的：探讨细胞学刷检与胆管内活检在胆管狭窄病因诊断中的比较效果。荟萃分析。转诊中心。对PubMed和Embase数据库进行了审查，以获得截至2014年4月发表的组织学诊断相关性研究。数据库和对研究结果的审查。敏感性和特异性。刷检诊断恶性胆管狭窄的敏感性和特异性分别为45%(95%可信区间，40%~50%)和99%(95%可信区间，98%~100%)。合并诊断恶性胆道狭窄的优势比为33.43(95%CI，14.29~78.24)。对于导管内活检，联合诊断的敏感性和特异性分别为48.1%(95%CI，42.8%~53.4%)和99.2%(95%CI，97.6%~99.8%)。合并诊断恶性胆道狭窄的优势比为43.18(95%CI，19.39~95.83)。两种方法的联合应用仅略微增加了敏感性(59.4%；95%CI，53.7%-64.8%)，特异性为100%(95%CI，98.8%-100.0%)。Begg-Mazumdar和Egger测试表明，发表偏见的可能性很低。纳入低质量的研究。我们的研究表明刷检和活检对于恶性胆管狭窄的诊断具有可比性和有限的敏感性。两者的结合只是略微增加了敏感度。
Evaluation of indeterminate biliary strictures typically involves collection and analysis of tissue or cells. Brush cytology and intraductal biopsies that are routinely performed during ERCP to assess malignant-appearing biliary strictures are limited by relatively low sensitivity. To study the comparative effectiveness of brushings for cytology and intraductal biopsies in the etiology of biliary strictures. Meta-analysis. Referral center. PUBMED and Embase databases were reviewed for studies published to April 2014 where diagnostic correlation of histology was available. Database and review of study findings. Sensitivity and specificity. The pooled sensitivity and specificity of brushings for the diagnosis of malignant biliary strictures was 45% (95% confidence interval [CI], 40%–50%) and 99% (95% CI, 98%–100%), respectively. The pooled diagnostic odds ratio to detect malignant biliary strictures was 33.43 (95% CI, 14.29–78.24). For intraductal biopsies, the pooled sensitivity and specificity were 48.1% (95% CI, 42.8%–53.4%) and 99.2% (95% CI, 97.6%–99.8%), respectively. The pooled diagnostic odds ratio to detect malignant biliary strictures was 43.18 (95% CI, 19.39–95.83). A combination of both modalities only modestly increased the sensitivity (59.4%; 95% CI, 53.7%–64.8%) with a specificity of 100% (95% CI, 98.8%–100.0%). The Begg-Mazumdar and Egger tests indicated a low potential for publication bias. Inclusion of low-quality studies. Our study suggests that both brushings and biopsy are comparable and have limited sensitivity for the diagnosis of malignant biliary strictures. A combination of both only modestly increases the sensitivity.