Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma

Weber, Andreas; Weyhern, Claus von; Fend, Falko; Schneider, Ján; Neu, Bruno; Meining, Alexander; Weidenbach, H; Schmid, Roland M.; Prinz, Christian

doi:10.3748/wjg.14.1097

Cited by 125 publications

(103 citation statements)

References 29 publications

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“…Due to its relative ease and safety, many studies have suggested that cytology during ERCP, despite its low sensitivity, remains a good choice for the diagnosis of causes of biliary stricture. [32][33][34][35] To improve the sensitivity, further refinements in technique and procedure have been suggested. One study of cytodiagnosis through ERCP showed that intraductal aspiration had a significantly higher sensitivity (89% versus 78% for adequate samples and 89% versus 37% for all samples) and significantly superior cellular adequacy (92.8% versus 35.7%) than brushing in patients with suspected malignant biliary stricture.…”

Section: Diagnosismentioning

confidence: 99%

A review of the clinical diagnosis and therapy of cholangiocarcinoma

2013

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Cholangiocarcinoma (CCA) is the second most common primary hepatic malignancy worldwide. The incidence of intrahepatic CCA is increasing, whereas that of extrahepatic CCA is decreasing. This review looks at the new advances that have been made in the management of CCA, based on a PubMed and Science Citation Index search of results from randomized controlled trials, reviews, and cohort, prospective and retrospective studies. Aggressive interventional approaches and new histopathological techniques have been developed to make a histological diagnosis in patients with high risk factors or suspected CCA. Resectability of the tumour can now be assessed using multiple radiological imaging studies; the main prognostic factor after surgery is a histologically negative resection margin. Biliary drainage and/or portal vein embolization may be performed before extended radical resection, or liver transplantation may be undertaken in combination with neoadjuvant chemotherapy or chemoradiotherapy. Though many advances have been made in the management of CCA, the standard modality of treatment has not yet been established. This review focuses on the clinical options for different stages of CCA.

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Section: Diagnosismentioning

confidence: 99%

A review of the clinical diagnosis and therapy of cholangiocarcinoma

2013

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“…In these published series, the sensitivity of brush cytology and forceps biopsy was evaluated in a heterogeneous patient group with several malignant bile duct strictures. Recently, the diagnostic sensitivity of transpapillary brush cytology and forceps biopsy was evaluated in patients with hilar cholangiocarcinomas [60] . In this series, the sensitivity of transpapillary brush cytology was 41.4% and the sensitivity of forceps biopsy was 53.4%.…”

Section: Brush Cytology and Forceps Biopsymentioning

confidence: 99%

Diagnostic approaches for cholangiocarcinoma

Weber

Schmid²,

Prinz³

2008

WJG

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Cholangiocarcinomas arise from the epithelial cells of the bile ducts and are associated with poor prognosis. Despite new diagnostic approaches, the definite diagnosis of this malignancy continues to be challenging. Cholangiocarcinomas often grow longitudinally along the bile duct rather than in a radial direction. Thus, large tumor masses are frequently absent and imaging techniques, including ultrasound, CT, and MRI have only limited sensitivity. Tissue collection during endoscopic (ERCP) and/or percutaneous transhepatic (PTC) procedures are usually used to confirm a definitive diagnosis of cholangiocarcinoma. However, forceps biopsy and brush cytology provide positive results for malignancy in about only 50% of patients. Percutaneous and peroral cholangioscopy using fiber-optic techniques were therefore developed for direct visualization of the biliary tree, yielding additional information about endoscopic appearance and tumor extension, as well as a guided biopsy acquistion. Finally, endoscopic ultrasonography (EUS) complements endoscopic and percutaneous approaches and may provide a tissue diagnosis of tumors in the biliary region through fineneedle aspiration. In the future, new techniques allowing for early detection, including molecular m a r ke r s , s h o u l d b e d e ve l o p e d t o i m p rove t h e diagnostic sensitivity in this increasing tumor entity.

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“…Biliary brushing cytology, although highly specific, has suffered from low to moderate sensitivity (15%Ϫ68%). [2][3][4][5][6] As a result, ancillary diagnostic techniques including mutation analysis, [7][8][9][10][11] DNA ploidy analysis, 12,13 methylation analysis, 14 -17 and fluorescence in situ hybridization (FISH), 2,4,18,19 have been studied to improve tumor detection.…”

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confidence: 99%

Comparison of KRAS Mutation Analysis and FISH for Detecting Pancreatobiliary Tract Cancer in Cytology Specimens Collected During Endoscopic Retrograde Cholangiopancreatography

Kipp

Fritcher

Clayton

et al. 2010

The Journal of Molecular Diagnostics

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Pancreatobiliary tract strictures result either from malignancies of the biliary tract and pancreas or from nonmalignant etiopathogenesis. The goal of this study was to determine whether KRAS mutations could be identified in residual pancreatobiliary stricture brushings and to compare the performance characteristics of KRAS mutation analysis to cytology and fluorescence in situ hybridization (FISH) for the detection of carcinoma. Residual brushing cytology cell pellets were retrieved from 132 patients with subsequent clinicopathologic follow-up of cholangiocarcinoma (n ‫؍‬ 41), pancreatic adenocarcinoma (n ‫؍‬ 35), gallbladder cancer (n ‫؍‬ 2), and nonmalignant strictures (n ‫؍‬ 54). All specimens had a prior cytology and FISH UroVysion results as part of clinical practice. KRAS mutation analysis was performed using the quantitative PCR DxS KRAS Mutation Test Kit. KRAS mutation analysis was successful in 130 of 132 specimens. KRAS mutations and polysomic (ie, positive) FISH results were identified in 24 (69%) and 22 (63%) pancreatic adenocarcinoma specimens, respectively, with a combined sensitivity of 86% (30/35). KRAS mutations and polysomic FISH results were identified in 12 (29%) and 17 (41%) cholangiocarcinoma specimens, with a combined sensitivity of 54% (22/41). KRAS mutations were identified in two patients with primary sclerosing cholangitis, and benign follow-up. Residual cytology specimens can be used to detect KRAS mutations by quantitative PCR. Combined KRAS mutation and FISH analysis appear to increase the cancer detection rate in patients with pancreatobiliary strictures.

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Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma

Abstract: Brush cytology and forceps biopsy have only limited sensitivity for the diagnosis of malignant hilar tumors. In our eyes, additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings.

Cited by 125 publications

References 29 publications

A review of the clinical diagnosis and therapy of cholangiocarcinoma

A review of the clinical diagnosis and therapy of cholangiocarcinoma

Diagnostic approaches for cholangiocarcinoma

Comparison of KRAS Mutation Analysis and FISH for Detecting Pancreatobiliary Tract Cancer in Cytology Specimens Collected During Endoscopic Retrograde Cholangiopancreatography

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