Abstract：
BACKGROUND: In primary sclerosing cholangitis (PSC), it is important to understand the cholangiographic findings suggestive of malignancy, but it is difficult to determine whether cholangiocarcinoma is present due to modifications caused by inflammation. This study aimed to clarify the appropriate method of pathological specimen collection during endoscopic retrograde cholangiopancreatography for surveillance of PSC.
METHODS: A retrospective observational study was performed on 59 patients with PSC. The endpoints were diagnostic performance for benign or malignant on bile cytology and transpapillary bile duct biopsy, cholangiographic findings of biopsied bile ducts, diameters of the strictures and upstream bile ducts, and their differences.
RESULTS: The sensitivity (77.8% vs. 14.3%, P = 0.04), specificity (97.8% vs. 83.0%, P = 0.04), and accuracy (94.5% vs. 74.1%, P = 0.007) were all significantly greater for bile duct biopsy than for bile cytology. All patients with cholangiocarcinoma with bile duct stricture presented with dominant stricture (DS). The diameter of the upstream bile ducts (7.1 (4.2-7.2) mm vs. 2.1 (1.2-4.1) mm, P < 0.001) and the diameter differences (6.6 (3.1-7) mm vs. 1.5 (0.2-3.6) mm, P < 0.001) were significantly greater in the cholangiocarcinoma group than in the noncholangiocarcinoma group with DS. For diameter differences, the optimal cutoff value for the diagnosis of benign or malignant was 5.1 mm (area under the curve = 0.972).
CONCLUSIONS: Transpapillary bile duct biopsy should be performed via localized DS with upstream dilation for the detection of cholangiocarcinoma in patients with PSC. Especially when the diameter differences are greater than 5 mm, the development of cholangiocarcinoma should be strongly suspected.
METHODS: A retrospective observational study was performed on 59 patients with PSC. The endpoints were diagnostic performance for benign or malignant on bile cytology and transpapillary bile duct biopsy, cholangiographic findings of biopsied bile ducts, diameters of the strictures and upstream bile ducts, and their differences.
RESULTS: The sensitivity (77.8% vs. 14.3%, P = 0.04), specificity (97.8% vs. 83.0%, P = 0.04), and accuracy (94.5% vs. 74.1%, P = 0.007) were all significantly greater for bile duct biopsy than for bile cytology. All patients with cholangiocarcinoma with bile duct stricture presented with dominant stricture (DS). The diameter of the upstream bile ducts (7.1 (4.2-7.2) mm vs. 2.1 (1.2-4.1) mm, P < 0.001) and the diameter differences (6.6 (3.1-7) mm vs. 1.5 (0.2-3.6) mm, P < 0.001) were significantly greater in the cholangiocarcinoma group than in the noncholangiocarcinoma group with DS. For diameter differences, the optimal cutoff value for the diagnosis of benign or malignant was 5.1 mm (area under the curve = 0.972).
CONCLUSIONS: Transpapillary bile duct biopsy should be performed via localized DS with upstream dilation for the detection of cholangiocarcinoma in patients with PSC. Especially when the diameter differences are greater than 5 mm, the development of cholangiocarcinoma should be strongly suspected.
摘要：
背景：在原发性硬化性胆管炎（PSC）中，了解提示恶性肿瘤的胆管造影结果很重要，但是由于炎症引起的改变，很难确定是否存在胆管癌。本研究旨在阐明内镜逆行胰胆管造影术中病理标本收集的适当方法，以监测PSC。
方法：对59例PSC患者进行回顾性观察研究。终点是胆汁细胞学检查和经乳头胆管活检对良性或恶性的诊断表现，活检胆管的胆管造影结果，狭窄和上游胆管的直径，和他们的差异。
结果：灵敏度（77.8%vs.14.3%,P=0.04),特异性（97.8%vs.83.0%,P=0.04),和准确性(94.5%与74.1%,P=0.007）胆管活检均明显大于胆汁细胞学检查。所有胆管癌伴胆管狭窄患者均表现为显性狭窄（DS）。上游胆管的直径（7.1（4.2-7.2）mmvs.2.1(1.2-4.1)mm,P<0.001）和直径差异（6.6（3.1-7）mm与1.5(0.2-3.6)mm,P<0.001）在胆管癌组中明显高于DS的非胆管癌组。对于直径差异，诊断良性或恶性的最佳临界值为5.1mm(曲线下面积=0.972).
结论：对于PSC患者，应通过带上游扩张的局部DS进行经胆管活检，以检测胆管癌。特别是当直径差大于5毫米时，应强烈怀疑胆管癌的发展。
方法：对59例PSC患者进行回顾性观察研究。终点是胆汁细胞学检查和经乳头胆管活检对良性或恶性的诊断表现，活检胆管的胆管造影结果，狭窄和上游胆管的直径，和他们的差异。
结果：灵敏度（77.8%vs.14.3%,P=0.04),特异性（97.8%vs.83.0%,P=0.04),和准确性(94.5%与74.1%,P=0.007）胆管活检均明显大于胆汁细胞学检查。所有胆管癌伴胆管狭窄患者均表现为显性狭窄（DS）。上游胆管的直径（7.1（4.2-7.2）mmvs.2.1(1.2-4.1)mm,P<0.001）和直径差异（6.6（3.1-7）mm与1.5(0.2-3.6)mm,P<0.001）在胆管癌组中明显高于DS的非胆管癌组。对于直径差异，诊断良性或恶性的最佳临界值为5.1mm(曲线下面积=0.972).
结论：对于PSC患者，应通过带上游扩张的局部DS进行经胆管活检，以检测胆管癌。特别是当直径差大于5毫米时，应强烈怀疑胆管癌的发展。
