A PROSPECTIVE-STUDY OF BILIARY CYTOLOGY IN 100 PATIENTS WITH BILE-DUCT STRICTURES
A PROSPECTIVE-STUDY OF BILIARY CYTOLOGY IN 100 PATIENTS WITH BILE-DUCT STRICTURES
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DOI：
10.1002/hep.1840180618
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发表时间：
1993-12-01
期刊：
影响因子：
13.5
通讯作者：
DAVIDSON, BR
中科院分区：
文献类型：
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作者：
KURZAWINSKI, TR;DEERY, A;DAVIDSON, BR
由于胆道狭窄导致梗阻性黄疸的患者，组织诊断是必不可少的，因为有多种治疗方案可供选择。胆管狭窄的影像学检查可能提示恶性，但只有组织学诊断才是决定性的。由于难以获得活检组织，因此鼓励了细胞学在这一领域的应用。本研究前瞻性分析了胆汁脱落细胞学和刷检细胞学检查对肝硬化的诊断价值。100例经内镜逆行胰胆管造影或经皮经肝胆管造影诊断为胆管狭窄的连续患者（60例男性和40例女性;中位年龄= 71岁，范围= 31 - 91岁）接受了胆管细胞学检查，并分为两组。第1组包括前47例患者，仅通过胆汁细胞学进行研究;第2组包括随后的46例患者，通过胆汁和刷检细胞学技术进行研究。7名患者因随访信息不足而被排除在分析之外。一位经验丰富的细胞学家检查了所有样本，以确定它们是否为肿瘤。恶性狭窄81例，良性狭窄12例。联合胆汁和刷检细胞学检查（第2组）比单独胆汁细胞学检查（第1组）更敏感（69% [27/39] vs. 33% [16/42]，p < 0.01）。在胆汁和刷检细胞学方法研究的患者中（第2组），刷检细胞学研究更敏感（69%对26%，p < 0.01）。 两组均未报告假阳性结果（特异性= 100%）。未发生手术相关并发症。胆汁细胞学检查是获得组织诊断的有效方法，刷拭法比胆汁细胞学检查更敏感。 细胞取样是快速和安全的，应该在胆管狭窄的情况下常规进行。
In patients with obstructive jaundice due to biliary tract stricture a tissue diagnosis is essential because of the varied treatment options available. Radiological imaging of a biliary stricture may suggest that it is malignant, but only a tissue diagnosis can be conclusive. The difficulty of obtaining biopsy tissue has encouraged the use of cytology in this field. This study prospectively analyzed the diagnostic value of exfoliative bile and brush cytology methods. One hundred consecutive patients with biliary strictures diagnosed at endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography (60 men and 40 women; median age = 71 yr, range = 31 to 91 yr) underwent biliary cytology and were divided into two groups. Group 1 comprised the first 47 patients, who were studied by means of bile cytology alone; and group 2 comprised the subsequent 46 patients, who were studied by means of bile and brush cytology techniques. Seven patients were excluded from analysis because of inadequate follow-up information. A single experienced cytologist examined all samples to determine whether they were neoplastic. Eighty-one patients had malignant strictures and 12 had benign strictures. Combined bile and brush cytology (group 2) was more sensitive than bile cytology alone (group 1) (69% [27 of 39] vs. 33% [16 of 42], p < 0.01). In the patients studied by means of bile and brush cytology methods (group 2), cytologic study of brushings was more sensitive (69% vs. 26%, p < 0.01). No false-positive results were reported in either group (specificity = 100%). No procedure-related complications occurred. Sampling time averaged less than 5 min. Biliary cytology is an effective way of obtaining a tissue diagnosis, with brush methods more sensitive than bile cytology. Cell sampling is rapid and safe to perform and should be done routinely in cases of biliary stricture.