ERCP形态学联合影像学及血清学评估胆管狭窄的临床价值

Clinical value of ERCP morphology combined with imaging and serology in evaluating biliary stricture

目的确定血清学和影像学等检查手段的加入是否能够提高内镜下逆行胰胆管造影(endoscopic retrograde cholangiopeacreatography,ERCP)细胞学刷检和活检诊断胆管狭窄的敏感度。方法回顾性分析行ERCP细胞学刷检的胆管狭窄患者,计算单个或组合检查手段的敏感度及特异度,包括组织学活检、血清糖类抗原199(carbohydrate antigen 199,CA199)、血清癌胚抗原(carcino-embryonic antigen,CEA)、腹部超声、CT检查和MRI检查。结果本研究共纳入352例行ERCP细胞学刷检的患者,细胞学刷检敏感度为59.6%,特异度为100.0%;其中261例联合组织学活检敏感度提高至82.7%,特异度为100.0%。194例(57.8%)患者行组织学、血清学或者影像学检查。当CA199和CEA分别以49.01 U/mL和2.82 ng/mL为临界值时,将影像学和血清学与ERCP刷检及活检结合,敏感度可提高至99.0%和98.9%,特异度分别降至75.0%和57.1%,四者联合应用敏感度提高至100.0%,特异度为28.6%。但并不影响临床处理,临床主要以形态学结果的特异度为准。结论ERCP液基细胞学联合组织学活检、血清学和影像学检查手段可提高胆管狭窄诊断的敏感度。

Objective To determine whether the addition of serological,radiological and other examination methods increases the diagnostic sensitivity of endoscopic retrograde cholangiopancreatography(ERCP)cytological brush and biopsy of biliary strictures.Methods A retrospective study was conducted on patients with biliary strictures using ERCP brush cytology,and the sensitivity and specificity of single or combined examination methods were calculated,including histological biopsy,serum carbohydrate antigen 19-9(CA19-9),carcino-embryonic antigen(CEA),abdominal ultrasound,CT,and MRI.Results A total of 352 patients undergoing ERCP cytological brush were included in this study,among which 261 cases had ERCP biopsy as well.The cytological sensitivity and specificity of liquid based brush examination were 59.6%and 100.0%,and the sensitivity of ERCP brush test combined with histological biopsy was increased to 82.7%and the specificity was 100.0%.There were 194 patients(57.8%)with relatively complete data,including histology,serology and imaging.When CA19-9 and CEA had 49.01 U/mL and 2.82 ng/mL as critical values,combining imaging and serology with ERCP brush test and biopsy,the sensitivity could reach 99.0%and 98.9%,and the specificity decreased to 75.0%and 57.1%,respectively.The sensitivity of combined application of the four detection methods was 100.0%and the specificity was 28.6%.However,it did not affect the clinical treatment,which was mainly based on the specificity of morphological results.Conclusions ERCP liquid based cytology combined with histological biopsy,serology,and imaging can significantly improve the sensitivity of the diagnosis of biliary strictures.