Öz
Backgaround and Aims:Endoscopic retrograde cholangio pancreatogaphy guided bile duct cytology for the diagnosis of indeterminate bile duct strictures is commonly used. The aim of this study was to define sensitivity, specificity, and positive and negative predictive values of endoscopic retrograde cholangio pancreatogaphy brush cytology from indeterminate biliary strictures. Materials and Methods:We retrospectively analyzed diagnostic yield of brush cytology in indeterminate biliary strictures in our single center, between January 2013 and April 2014. Demographic data, endoscopic retrograde cholangio pancreatogaphy reports, pathology reports, post-endoscopic retrograde cholangio pancreatogaphy operation, percutaneous biopsy results, the course of the disease and survival of the patientswere recorded. Results:Cytologic examination of thirty seven samples were done in 35 patients. The mean age of patients was 63.7±12 years. There were 19 females and 16 males. Three patients had adenocarcinoma, one high grade dysplasia and one low grade dysplasia, which were detected at cytological evaluation. Twenty samples were reported as normal with sufficient material; 3 were reported as insufficient material; and 9 were reported as indeterminate. The diagnosis of malignancy was confirmed with other methods in 4 patients. Follow-up data was obtained in 13 of 18 malignancy negative patients. Ten of the 13 patients were detected negative for malignancy and 3 were diagnosed malignant with additional examinations. Also, 3 out of 12 patients whose cytological results were insufficient or indeterminate were diagnosed malignant after additional examinations; the remaining 9 patients were found negative for malignancy. In accuracy analysis, the sensitivity of brush cytology was calculated as 57.1%, specificity 100%, positive predictive value 100% and negative predictive value 76.9%. Conclusion:In cases with indeterminate biliary strictures, positive predictive value of brush cytology was high but negative cytology results do not exclude malignancy. Cases with high suspicion of malignancy must be evaluated with additional examinations
Anahtar Kelimeler
Endoscopic retrograde cholangio pancreatogaphy common bile duct brush cytology
Kaynakça
- 1. Temiño López-Jurado R, Cacho Acosta G, Argüelles Pintos M, et al. Diagnostic yield of brush cytology for biliary stenosis during ERCP. Rev Esp Enferm Dig 2009;101:385-9, 390-4.
- 2. De Bellis M, Sherman S, Fogel EL, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (Part 1). Gastrointest Endosc 2002;56:552-61.
- 3. De Bellis M, Sherman S, Fogel EL, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (Part 2). Gastrointest Endosc. 2002;56:720-30.
- 4. Dickson PV, Behrman SW. Distal cholangiocarcinoma. Surg Clin North Am 2014;94:325-42.
- 5. García-Cano J. Endoscopic management of benign biliary strictures. Curr Gastroenterol Rep 2013;15:336.
- 6. Mansfield JC, Griffin SM, Wadehra V, Matthewson K. A prospective evaluation of cytology from biliary strictures. Gut 1997;40:671-7.
- 7. Moreno Luna LE, Kipp B, Halling KC, et al. Advanced cytologic techniques for the detection of malignant pancreatobiliary strictures. Gastroenterology 2006;131:1064-72.
- 8. Weber A, von Weyhern C, Fend F, et al. Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma. World J Gastroenterol 2008;14:1097-101.
- 9. Shieh FK, Luong-Player A, Khara HS, et al. Improved endoscopic retrograde cholangiopancreatography brush increases diagnostic yield of malignant biliary strictures. World J Gastrointest Endosc 2014;6:312-7.
- 10. Urbano M, Rosa A, Gomes D, et al. Team approach to ERCP-directed single-brush cytology for the diagnosis of malignancy. Rev Esp Enferm Dig 2008;100:462-5.
- 11. Joo I, Lee JM. Imaging bile duct tumors: pathologic concepts, classification, and early tumor detection. Abdom Imaging 2013;38:1334-50.
Öz
Giriş ve Amaç: Endoskopik retrograd kolanjiopankreatografi esnasında alınan fırça sitolojisi şüpheli koledok darlıkları tanısında yaygın olarak kullanılmaktadır.
Çalışmamızda kliniğimizde şüpheli koledok darlığı olan olgulardan
alınan fırça sitolojisi sonuçlarının sensitivite, spesifite, pozitif prediktif
değer ve negatif prediktif değerini değerlendirmeyi amaçladık. Gereç-Yöntem:
Ocak 2013 ile Nisan 2014 tarihleri arasında endoskopik retrograd kolanjiopankreatografi
sırasında malign darlıktan şüphelenilerek fırça sitolojisi
yapılan hastaların demografik verileri, endoskopik retrograd kolanjiopankreatografi
raporları, patoloji raporları ve varsa endoskopik retrograd kolanjiopankreatografi
sonrası ameliyat/görüntüleme eşliğinde biyopsi bulguları ve
hastalığın seyri ve hastaların sürvileri retrospektif olarak incelendi. Bulgular:
Ocak 2013 ile Nisan 2014 tarihleri arasında 35 hastaya 37 işlem yapılarak
fırça sitolojisi alındı. Hastaların ortalama yaşı 63.7±12 yıl idi. Vakaların 19’u
kadın, 16’sı erkekti. Sitolojik değerlendirme sonuçlarına göre, 3 olguda adenokanser,
1 olguda ileri dereceli displazi ve 1 olguda düşük dereceli displazi
saptandı. Sitolojik incelemelerin 20’si hücresel değerlendirme için materyal
yeterli ve malignite negatif (2’si tekrar), 3’ü yetersiz materyal ve 9’u indetermine
olarak raporlandı. Fırça sitolojisi malign olan 4 olgunun tanısı diğer
yöntemlerle de doğrulandı. Düşük dereceli displazili hastada ek inceleme
yoktu. Malignite negatif olan 18 hastanın 13’ünün takip verilerine ulaşıldı. Bu
13 hastanın 10’unda takip incelemeleri ile malignite saptanmazken, 3’ünde
malignite saptandı. Ayrıca sitoloji sonucu yeterli olmayan ya da indetermine
tespit edilen 12 hastanın 3’ünde çeşitli tetkik ve girişimlerle karsinom tanısı
konuldu, 9 hastada malignite yoktu. Doğruluk analizi yapıldığında fırça sitolojisi
için sensitivite %57.1, spesifite %100, pozitif prediktif değer %100
ve negatif prediktif değer %76.9 olarak hesaplandı. Sonuç: Malign koledok
darlığı şüphesi olan olgularda fırça sitolojisinin pozitif prediktif değeri yüksek
olmakla birlikte negatif gelmesi maligniteyi ekarte ettirmemekte; malignite
şüphesi kuvvetli olan olgularda incelemenin diğer tetkiklerle desteklenmesi
gereklidir.
Anahtar Kelimeler
Endoskopik retrograd kolanjiopankreatografi koledok fırça sitolojisi
Kaynakça
- 1. Temiño López-Jurado R, Cacho Acosta G, Argüelles Pintos M, et al. Diagnostic yield of brush cytology for biliary stenosis during ERCP. Rev Esp Enferm Dig 2009;101:385-9, 390-4.
- 2. De Bellis M, Sherman S, Fogel EL, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (Part 1). Gastrointest Endosc 2002;56:552-61.
- 3. De Bellis M, Sherman S, Fogel EL, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (Part 2). Gastrointest Endosc. 2002;56:720-30.
- 4. Dickson PV, Behrman SW. Distal cholangiocarcinoma. Surg Clin North Am 2014;94:325-42.
- 5. García-Cano J. Endoscopic management of benign biliary strictures. Curr Gastroenterol Rep 2013;15:336.
- 6. Mansfield JC, Griffin SM, Wadehra V, Matthewson K. A prospective evaluation of cytology from biliary strictures. Gut 1997;40:671-7.
- 7. Moreno Luna LE, Kipp B, Halling KC, et al. Advanced cytologic techniques for the detection of malignant pancreatobiliary strictures. Gastroenterology 2006;131:1064-72.
- 8. Weber A, von Weyhern C, Fend F, et al. Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma. World J Gastroenterol 2008;14:1097-101.
- 9. Shieh FK, Luong-Player A, Khara HS, et al. Improved endoscopic retrograde cholangiopancreatography brush increases diagnostic yield of malignant biliary strictures. World J Gastrointest Endosc 2014;6:312-7.
- 10. Urbano M, Rosa A, Gomes D, et al. Team approach to ERCP-directed single-brush cytology for the diagnosis of malignancy. Rev Esp Enferm Dig 2008;100:462-5.
- 11. Joo I, Lee JM. Imaging bile duct tumors: pathologic concepts, classification, and early tumor detection. Abdom Imaging 2013;38:1334-50.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Aralık 2014 |
| Yayımlandığı Sayı | Yıl 2014 Cilt: 22 Sayı: 3 |