EUS-guided FNA of proximal biliary strictures after negative ERCP brush cytology results

DeWitt, John M.; Misra, Vijay Laxmi; Leblanc, Julia K.; McHenry, Lee; Sherman, Stuart

doi:10.1016/j.gie.2005.11.064

Cited by 204 publications

(135 citation statements)

References 44 publications

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“…However, only 12 reports have described EUS-FNA for biliary disease. Table 4 shows an overview of EUS-FNA for the biliary tract [Frischer-Ravens et al 2000Rösch et al 2004, Lee et al 2004Eloubeidi et al 2004;Byrne et al 2004;Meara et al 2006;DeWitt et al 2006;Mohamadnejad et al 2011;Ohshima et al 2011;Nayar et al 2011;Weilert et al 2014]. According to those reports, sensitivity and accuracy have been widely reported as 43-100% and 54-100%, respectively.…”

Section: Discussionmentioning

confidence: 99%

EUS-guided FNA for biliary disease as first-line modality to obtain histological evidence

Onda

Ogura

Kurisu

et al. 2016

Therap Adv Gastroenterol

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Background: Few reports have described endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) for biliary lesions. In addition, adverse events were not completely examined in previous reports, due to the inclusion of cases in which biliary stents had already been placed. The present study aimed to investigate the diagnostic yield and adverse events of EUS-FNA for biliary lesions as the first-line diagnostic modality for consecutive prospectively registered patients. Methods: Inclusion criteria were as follows: (1) patients with suspected cholangiocarcinoma (CCA) based on computed tomography or other imaging modalities; (2) patients who had not previously undergone endoscopic retrograde cholangiopancreatography or EUS-FNA; (3) absence of surgically altered anatomy, such as Roux-en-Y anastomosis or duodenal obstruction caused by tumor invasion, through which an endoscope could not pass; and (4) provision of written informed consent to all procedures associated with the study. Results: A total of 47 consecutive patients with suspected CCA were registered to this study. Sensitivity and accuracy were 89% and 87%, respectively. On multivariate analysis, puncture site was the only factor associated with reduced diagnostic yield (hazard ration, 6.879; 95% confidence interval, 1.172–40.374; P = 0.033). Remarkably, no adverse events such as bleeding or bile leakage were associated with EUS-FNA in any of the 47 patients. Conclusions: Our results suggest that EUS-FNA can be safely performed for biliary disease without biliary stenting. Furthermore, this procedure may warrant use as the first-line diagnostic method, although our results need to be validated in future prospective studies.

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Section: Discussionmentioning

confidence: 99%

EUS-guided FNA for biliary disease as first-line modality to obtain histological evidence

Onda

Ogura

Kurisu

et al. 2016

Therap Adv Gastroenterol

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“…In one study, 20% of patients with cholangiocarcinoma missed by conventional cytology were identified by FISH without affecting the specificity [28] . Several studies have evaluated the diagnostic yield of endoscopic US fine needle aspiration in patients with biliary strictures [29][30][31][32] . In one of the studies, the sensitivity and specificity of biopsy were 89% and 100%, respectively [30] .…”

Section: Discussionmentioning

confidence: 99%

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Kloek¹,

Delden²,

Erdogan³

et al. 2008

WJG

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AIM:To identify the criteria for the differentiation of hilar cholangiocarcinoma (HCCA) from benign strictures. METHODS: A total of 68 patients underwent resection of lesions suspicious for HCCA between 1998 and 2006. The results of laboratory investigations, imaging studies and brush cytology were collected. These findings were analyzed to obtain the final diagnosis. RESULTS: Histological examination of the resected specimens confirmed HCCA in 58 patients (85%, group Ⅰ) whereas 10 patients (15%, group Ⅱ) were diagnosed to have benign strictures. The most common presenting symptom was obstructive jaundice in 77% patients (79% group Ⅰ vs 60% group Ⅱ, P = 0.23). Laboratory findings showed greater elevation of transaminase levels in group Ⅰ compared to group Ⅱ. The various imaging modalities showed vascular involvement exclusively in the malignant group (36%, P < 0.05). Brush cytology was positive for malignant cells in only 50% patients in group Ⅰ whereas none in group Ⅱ showed malignant cells. CONCLUSION: Despite improvements in imaging techniques, 10 patients (15%) with a presumptive diagnosis of HCCA were ultimately found to have benign strictures. Except for vascular involvement which was associated significantly with malignancy, there were no conclusive features of malignancy on regular imaging modalities. This uncertainty should be taken into account when patients with a suspicious lesion at the liver hilum are considered for resection.

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“…If available, peroral cholangioscopy can also be attempted. EUS with fine needle aspiration is also emerging as a promising tool in the differential diagnosis of extrahepatic bile duct wall thickening as well [45] . If the suspected lesion is intrahepatic in location, PET can be utilized to ascertain its malignant nature by finding hot uptake at the suspected site [27] .…”

Section: A Proposed Algorithm For Detecting Early Bile Duct Cancer Inmentioning

confidence: 99%

“…Peroral cholangioscopy is more difficult for bile duct lesions above the hilum, because it has a limitation in the retroflexion capability of the scope tip [43] . Endoscopic ultrasound (EUS) appears to be an emerging technique to evaluate asymptomatic dilatation of extraheptic bile duct [44] , and EUS-guided fine needle aspiration and biopsy has a greater sensitivity for detecting a malignancy than ERCP with brush cytology in cases with extrahepatic bile duct wall thickening [45] . The percutaneous transhepatic cholangioscopy (PTCS) is useful for intrahepatic bile duct lesions in histological diagnosis.…”

mentioning

confidence: 99%

Early bile duct cancer

Myung

Kim²,

Jang³

2007

WJG

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EUS-guided FNA of proximal biliary strictures after negative ERCP brush cytology results

Cited by 204 publications

References 44 publications

EUS-guided FNA for biliary disease as first-line modality to obtain histological evidence

EUS-guided FNA for biliary disease as first-line modality to obtain histological evidence

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Early bile duct cancer

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