DNA定量分析与液基细胞学在胆管良恶性病变中的应用价值
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摘要
目的:对比内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)中胆管刷检液基细胞学、DNA定量分析结果,探讨ERCP胆管刷检液基细胞学及DNA定量分析在胆管疾病诊断中的应用价值。方法:选取ERCP胆管刷检病例同时做液基细胞学诊断及DNA定量分析,将其结果与组织学活检进行对比。结果:胆管刷检液基细胞学诊断恶性肿瘤41例,疑癌10例,核异质42例,阴性91例;DNA定量分析诊断见异倍体细胞102例,阴性82例;病理活检诊断癌90例,异型增生22例,阴性72例。液基细胞学诊断灵敏度、特异度分别为66.1%与70.8%。DNA定量分析的灵敏度、特异度分别为84.8%与95.8%。液基细胞学的诊断准确性为67.9%,DNA定量分析的诊断准确性为88.6%。DNA定量分析诊断的准确性、灵敏度及特异度较液基细胞学诊断高,二者比较差异有统计学意义(P<0.05)。结论:液基细胞学及DNA定量分析联合检测能提高胆道疾病的检出率,降低漏诊及误诊的风险。
Objective: To compare the liquid-based cytology and DNA quantitative analysis of bile duct brushing in endoscopic retrograde cholangiopancreatography(ERCP), and to explore the value of ERCP liquid-based cytology and DNA ploidy analysis in the diagnosis of bile duct diseases. Methods: Cholangio-brushing cases of ERCP were selected for liquid-based cytological diagnosis and DNA quantitative analysis, and the results were compared with histological biopsy. Results: A total of 41 malignant tumors, 10 suspected cancers, 42 nuclear heterogeneity and 91 negative cases were diagnosed by liquid-based cytology of bile duct brush examination;102 aneuploid cells and 82 negative cases were diagnosed by DNA quantitative analysis; 90 cancer cases were diagnosed by pathological biopsy, 22 dysplasia cases and 72 negative cases. The sensitivity and specificity of liquidbased cytology were 66.1% and 70.8%, respectively. The sensitivity and specificity of DNA quantitative analysis were 84.8% and 95.8%, respectively. The diagnostic accuracy of liquid-based cells was 67.9%, and that of DNA quantitative analysis was 88.6%. The diagnostic accuracy, sensitivity and specificity of DNA quantitative analysis were higher than those of liquid-based cytology(P<0.05). Conclusion: The combined detection of liquid-based cytology and DNA quantitative analysis can improve the detection rate of biliary tract diseases and reduce the risk of missed diagnosis and misdiagnosis.
Objective: To compare the liquid-based cytology and DNA quantitative analysis of bile duct brushing in endoscopic retrograde cholangiopancreatography(ERCP), and to explore the value of ERCP liquid-based cytology and DNA ploidy analysis in the diagnosis of bile duct diseases. Methods: Cholangio-brushing cases of ERCP were selected for liquid-based cytological diagnosis and DNA quantitative analysis, and the results were compared with histological biopsy. Results: A total of 41 malignant tumors, 10 suspected cancers, 42 nuclear heterogeneity and 91 negative cases were diagnosed by liquid-based cytology of bile duct brush examination;102 aneuploid cells and 82 negative cases were diagnosed by DNA quantitative analysis; 90 cancer cases were diagnosed by pathological biopsy, 22 dysplasia cases and 72 negative cases. The sensitivity and specificity of liquidbased cytology were 66.1% and 70.8%, respectively. The sensitivity and specificity of DNA quantitative analysis were 84.8% and 95.8%, respectively. The diagnostic accuracy of liquid-based cells was 67.9%, and that of DNA quantitative analysis was 88.6%. The diagnostic accuracy, sensitivity and specificity of DNA quantitative analysis were higher than those of liquid-based cytology(P<0.05). Conclusion: The combined detection of liquid-based cytology and DNA quantitative analysis can improve the detection rate of biliary tract diseases and reduce the risk of missed diagnosis and misdiagnosis.
引文
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15.张素霞,周红,宇小婷,等.全自动DNA定量分析检测对恶性胸腔积液诊断的价值[J].中华病理学杂志,2015,44(9):653-654.ZHANG Suxia,ZHOU Hong,YU Xiaoting,et al.Automatic DNAquantitative analysis the value of detection of malignant pleural effusion diagnosis[J].Chinese Journal of Pathology,2015,44(9):653-654.
16.石安琪,江涛.DNA定量分析在肺癌诊断中的应用价值[J].现代医药卫生,2018,34(10):1502-1504.SHI Anqi,JIANG Tao.DNA ploidy analysis value in the diagnosis of lung cancer[J].Journal of Modern Medicine&Health,2018,34(10):1502-1504.
17.Maraki D,Becker J,Boecking A.Cytologic and DNA-cytometric very early diagnosis of oral cancer[J].J Oral Pathol Med,2004,33(7):398-404.
18.黄平,张筱风,张啸,等.胆管腔内超声联合细胞刷检病理、基因突变检测对胆管恶性狭窄的早期定性诊断价值[J].中华消化内镜杂志,2014,31(12):685-689.HUANG Ping,ZHANG Xiaofeng,ZHANG Xiao,et al.Bile duct intracavitary ultrasonic joint brush cell pathology,gene mutation detection early qualitative diagnostic value of malignant bile duct stenosis[J].Chinese Journal of Digestive Endoscopy,2014,31(12):685-689.
2.金浩,刘会春,李宗狂,等.超细胆道镜在经皮经肝途径胆管肿瘤活检中的应用[J].中国微创外科杂志,2017(8):698-700.JIN Hao,LIU Huichun,LI Zongkuang,et al.Ultrafine choledochoscope in percutaneous through liver bile duct tumor biopsies[J].Chinese Journal of Minimally Invasive Surgery,2017(8):698-700.
3.Vazquez-Sequeiros E,Baron TH,Clain JE,et a1.Evaluation of indeterminate bile duct strictures by intraductal US[J].Gastrointest Endosc,2002,56(3):372-379.
4.刘素丽,王鼎鑫,邢国璋,等.内镜下胆管癌组织活检方法研究[J].中国内镜杂志,2009,15(5):456-457.LIU Suli,WANG Dingxin,XING Guozhang,et al.Endoscopic bile duct carcinoma tissue biopsy method research[J].China Journal of Endoscopy,2009,15(5):456-457.
5.陈昆仑,翟文龙.胆管癌的治疗现状[J].中华肝脏外科手术学电子杂志,2017,6(6):447-449.CHEN Kunlun,ZHAI Wenlong.The treatment of bile duct carcinoma[J].Chinese Journal of Hepatic Surgery.Electronic Edition,2017,6(6):447-449.
6.孙力祺,金震东.内镜新技术在胆胰疾病诊断中的应用[J].临床肝胆病杂志,2018,34(3):467-472.SUN Liqi,JIN Zhendong.New technology of endoscopy in the diagnosis of biliary pancreatic diseases[J].Chinese Journal of Clinical Hepatology,2018,34(3):467-472.
7.谢雨佳,张俊文.经内镜逆行胰胆管造影术并发症的防治研究进展[J].现代医药卫生.2018,34(16):2496-2499.XIE Yujia,ZHANG Junwen.Advances in the prevention and treatment of complications of retrograde endoscopic cholangiopancreatography[J].Modern Medicine Health,2018(16):2496-2499.
8.王伟,黄晓俊,王祥,等.ERCP联合胆管腔内超声及胆管活检对胆管良恶性狭窄的诊断价值[J].中国微创外科杂志,2018,18(8):677-681.WANG Wei,HUANG Xiaojun,WANG Xiang,et al.ERCP combined bile ducts cavity ultrasound and bile duct biopsy in the diagnosis of benign and malignancy narrowness of bile duct value[J].Chinese Journal of Minimally Invasive Surgery,2018,18(8):677-681.
9.金晓昇,陈璐茜,季婷婷.ERCP胆管支架置入治疗晚期恶性梗阻性黄疸的疗效研究[J].中华全科医学,2018,16(10):1643-1645.JIN Xiaosheng,CHEN Luqian,JI Tingting.ERCP bile duct stenting treatment the curative effect of late malignant obstructive jaundice study[J].Applied Journal of General Practice,2018(10):1643-1645.
10.Zhou Y,Liu S,Wu L,et al.Survival after surgical resection of distal cholangiocarcinoma:a systematic review and meta-analysis of prognostic factors[J].Asian J Surg,2017,40(2):129-138.
11.黄平,张筱风,张啸,等.经内镜逆行胰胆管造影途经下腔内超声及细胞刷对胆管恶性狭窄的早期诊断价值[J].中华肝胆外科杂志,2013,19(9):661-664.HUANG Ping,ZHANG Xiaofeng,ZHANG Xiao,et al.Through ercp inferior vena brush ultrasound and cells within the early diagnostic value of malignant bile duct stenosis[J].Chinese Journal of Hepatobiliary Surgery,2013,19(9):661-664.
12.Burnett AS,Calvert TJ,Chokshi R J.Sensitivity of endoscopic retrograde cholangiopancreatography standard cytology:10-y review of the literature[J].J Surg Res,2013,184(1):304-311.
13.Fogel EL,deBellis M,McHenry L,et al.Effectiveness of a new long cytology brush in the evaluation of malignant biliary obstruction:a prospective study[J].Gastrointest Endosc,2006,63(1):71-77.
14.Macey R.DAN-image cytometry and computer-assisted brush biopsy have potential as diagnostic tools for clinicaly suspectedoral precancer and oral cancer[J].J Evid Based Dent Pract,2016,16(2):113-114.
15.张素霞,周红,宇小婷,等.全自动DNA定量分析检测对恶性胸腔积液诊断的价值[J].中华病理学杂志,2015,44(9):653-654.ZHANG Suxia,ZHOU Hong,YU Xiaoting,et al.Automatic DNAquantitative analysis the value of detection of malignant pleural effusion diagnosis[J].Chinese Journal of Pathology,2015,44(9):653-654.
16.石安琪,江涛.DNA定量分析在肺癌诊断中的应用价值[J].现代医药卫生,2018,34(10):1502-1504.SHI Anqi,JIANG Tao.DNA ploidy analysis value in the diagnosis of lung cancer[J].Journal of Modern Medicine&Health,2018,34(10):1502-1504.
17.Maraki D,Becker J,Boecking A.Cytologic and DNA-cytometric very early diagnosis of oral cancer[J].J Oral Pathol Med,2004,33(7):398-404.
18.黄平,张筱风,张啸,等.胆管腔内超声联合细胞刷检病理、基因突变检测对胆管恶性狭窄的早期定性诊断价值[J].中华消化内镜杂志,2014,31(12):685-689.HUANG Ping,ZHANG Xiaofeng,ZHANG Xiao,et al.Bile duct intracavitary ultrasonic joint brush cell pathology,gene mutation detection early qualitative diagnostic value of malignant bile duct stenosis[J].Chinese Journal of Digestive Endoscopy,2014,31(12):685-689.