Pancreatic and bile duct brushing cytology in 1000 cases - Review of findings and comparison of preparation methods
Pancreatic and bile duct brushing cytology in 1000 cases - Review of findings and comparison of preparation methods
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DOI：
10.1002/cncr.21842
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发表时间：
2006-08-25
影响因子：
3.4
通讯作者：
Creager, Andrew J.
中科院分区：
文献类型：
--
作者：
Volmar, Keith E.;Vollmer, Robin T.;Creager, Andrew J.
背景胰管刷检细胞学是评价肝外胆管和大胰管的重要工具。新辅助治疗的出现强调了通过非侵入性手段进行准确术前诊断的重要性。基于液体的制备方法，如ThinPrep，已成为流行的非妇科细胞学的医生。回顾了1994 - 2003年10年期间的胆管和胰管刷检结果。细胞学资料，影像学报告，临床资料进行了审查，病理和临床随访资料。仅直接涂片法（18.8%）、直接涂片加细胞离心涂片法（14.4%）或直接涂片加ThinPrep法（66.8%）制备玻片。共鉴定864例患者的1118个标本（1008个胆管，110个胰管）。细胞学结果为：53.5%阴性，16.5%恶性，18.2%可疑恶性，11%不典型/不确定，0.8%不充分。82.2%的病例（n = 971）进行了组织学或至少6个月临床观察形式的随访。总体操作特征为：灵敏度52.6%，特异性99.4%，阳性预测值98.9%，阴性预测值67.1%，准确性75.7%。细胞学和随访之间的诊断一致性是分析的主要变量。一致性受取样病变特征的显著影响，导管狭窄的恶性率最低。此外，与其他制备方法相比，ThinPrep方法显示出更高的灵敏度和准确性（P =.02）。患者年龄、性别、病变部位、是否存在结石或既往支架植入均无显著相关性。在来自单个机构的大数据集中，刷拭细胞学显示出适度的灵敏度和高特异性。良性病例的诊断一致性要好得多。直接涂片和ThinPrep方法的结合显示出优越的灵敏度和准确性。癌症（癌症细胞病理学）2006; 108：231 - 8。(c)2006美国癌症协会
BACKGROUND. Duct brushing cytology is an important tool in evaluation of the extrahepatic biliary tract and large pancreatic ducts. The emergence of neoadjuvant therapies underscores the importance of accurate preoperative diagnosis by noninvasive means. Liquid-based preparation methods, such as ThinPrep, have become popular for nongynecologic cytology specimens.METHODS. Findings from bile and pancreatic duct brushings were reviewed over the 10-year period of 1994-2003. Cytologic material, imaging reports, and clinical data were reviewed and pathologic and clinical follow-up data were obtained. The slides were prepared by direct smear only (18.8%), direct smear plus cytospin (14.4%), or direct smear plus ThinPrep (66.8%).RESULTS. A total of 1118 specimens were identified (1008 bile duct, 110 pancreatic duct) from 864 patients. The cytologic findings were: 53.5% negative, 16.5% malignant, 18.2% suspicious for malignancy, 11% atypical/inconclusive, 0.8% inadequate. Follow-up in the form of either histology or at least 6 months clinical observation was available for 82.2% of cases (n=971). Overall operating characteristics were: 52.6% sensitivity, 99.4% specificity, 98.9% positive predictive value, 67.1% negative predictive value, and 75.7% accuracy. Diagnostic agreement between cytology and follow-up was the main variable analyzed. Agreement was significantly affected by characteristics of the sampled lesion, with ductal narrowing having the lowest rate of malignancy. In addition, the ThinPrep method showed superior sensitivity and accuracy compared with other preparation methods (P =.02). Nonsignificant associations were noted for patient age and gender, site of lesion, and the presence of either stones or prior stent.CONCLUSION. in a large dataset from a single institution, brushing cytology showed modest sensitivity and high specificity. Diagnostic agreement was considerably better for benign cases. The combination of direct smear and the ThinPrep method showed superior sensitivity and accuracy. Cancer (Cancer Cytopathol) 2006;108:231-8. (c) 2006 American Cancer Society.