Long-Term Outcomes of Positive Fluorescence In Situ Hybridization Tests in Primary Sclerosing Cholangitis
Long-Term Outcomes of Positive Fluorescence In Situ Hybridization Tests in Primary Sclerosing Cholangitis
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DOI：
10.1002/hep.23277
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发表时间：
2010-01-01
期刊：
影响因子：
13.5
通讯作者：
Lindor, Keith D.
中科院分区：
文献类型：
--
作者：
Bangarulingam, Sanjay Y.;Bjornsson, Einar;Lindor, Keith D.
原发性硬化性胆管炎（PSC）患者发生胆管癌（CCA）的风险增加。荧光原位杂交（FISH）是一种旨在提高早期CCA诊断的细胞学检测。FISH检测阳性的PSC患者（多体性、三体性/四体性）的长期结局尚不清楚。所有至少进行过一次FISH检测的PSC患者，如果他们在肝移植后的外植体中有阳性组织活检、阳性细胞学检查或癌症证据，则确定并定义为CCA。共235例PSC患者进行了至少一次FISH检测，56例患者在组织病理学（n = 35）或细胞学（n = 21）上有CCA。总体而言，235例PSC患者中有120例（51%）进行了FISH检测，但这些阳性患者中只有三分之一患有CCA。FISH多体性的敏感性和特异性分别为46%和88%，三体/四体分别为25%和67%。生存分析显示，FISH多体性患者的结局与CCA患者相似;而FISH三体/四体性患者的结局与阴性FISH试验患者相似。与CCA患者相比，FISH多体性无癌患者的血清胆红素较低，碳水化合物抗原19-9（CA 19-9）较低，马约风险评分较低，显性狭窄发生率较低。结论：在PSC患者中，显性狭窄加FISH多体性的存在对CCA的特异性为88%。FISH显示三体或四体的患者与FISH阴性的患者具有相似的结果。FISH检测应选择性地用于有其他迹象表明CCA的患者，而不是作为所有接受内镜逆行胰胆管造影术（ERCP）的PSC患者的筛查工具。（《肝脏学》2010年;51：174-180）
Patients with primary sclerosing cholangitis (PSC) are at increased risk for developing cholangiocarcinoma (CCA). Fluorescence in situ hybridization (FISH) is a cytological test designed to enhance early CCA diagnosis. The long-term outcome of PSC patients with a positive FISH test (polysomy, trisomy/tetrasomy) are unclear. All PSC patients with at least one FISH test were identified and defined to have CCA if they had a positive tissue biopsy, positive cytology, or evidence of cancer in the explant after liver transplantation. A total of 235 PSC patients had at least one FISH test performed, and 56 patients had CCA on histopathology (n = 35) or cytology (n = 21). Overall, 120 of 235 (51%) of PSC patients tested for FISH were positive, but only one third of these positive patients had CCA. Sensitivity and specificity for FISH polysomy were 46% and 88%, and for trisomy/tetrasomy they were 25% and 67%, respectively. Survival analysis showed that patients with FISH polysomy had an outcome similar to patients with CCA; whereas FISH trisomy/tetrasomy patients had an outcome similar to patients with negative FISH tests. The FISH polysomy patients without cancer compared with those with CCA had lower serum bilirubin, lower carbohydrate antigen 19-9 (CA 19-9), lower Mayo risk score, and lower occurrence of dominant strictures. Conclusion: In PSC patients, the presence of a dominant stricture plus FISH polysomy has a specificity of 88% for CCA. Patients with FISH showing trisomy or tetrasomy have a similar outcome to patients with negative FISH. FISH testing should be used selectively in patients with other signs indicating CCA and not as a screening tool in all PSC patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). (HEPATOLOGY 2010;51:174-180.)