胆道系悪性腫瘍確定診断法としての胆汁細胞診

Studies on the Cytologic Examination of Bile for Definitive Diagnosis of Cancers of the Gallbladder and Biliary Tract

はじめに

　胆囊癌，胆管癌の確定診断としては細胞診あるいは組織診による以外に適格な方法はない．しかし現状では，術前に生検を施行してその組織診を得ることは困難であり不可能に近い．そこで筆者らは教室で施行している経皮経肝性胆道造影の際に，経皮的に採取した胆汁の細胞診をおこない，臨床的に胆汁細胞診による術前確定診断を確立したので，その方法および成績について述べる．

　For definitive diagnosis of cancer of the gallbladder and bile duct, a technique and its results in the cytological examination of bile have been studied, together with an analysis of data thus obtained in four carcinomas of the gallbaldder and nine of biliary tract.

　For cellular materials for this investigation, not only bile but also physiologic saline and contrast medium, with which the gallbladder and biliary tract were washed, were used as well. During the percutaneous transhepatic cholangiography, bile was aspirated and physiologic saline and contrast medium thus washed with were also collected. For fixation, 99.5 per cent ethylalcohol was found most suitable for making cellular characteristics clear. In addition to the smear slides with Papanicolaou (Papanicolaou's) stain, cell-block slides with H. E. stain was also of great help in establishing diagnosis.

　Accuracy of preoperative diagnosis was 75 per cent in carcinoma of the gallbladder and 80 per cent in that of the biliary tract. There was no false positive observation. Slightly dysplastic cells were reported in some diseases of the biliary tract, but operative findings and cytological study proved them to be due to its inflammatory diseases and gallstones.

　Diagnostic accuracy of this method does not depend on the localization and size of tumor or on the extent of invasive and metastatic lesions, but on the positioning in aspiration of bile and the methods of collecting cytologic materials.