Intraductal aspiration: a promising new tissue-sampling technique for the diagnosis of suspected malignant biliary strictures

Curcio, Gabriele; Traina, Mario; Mocciaro, Filippo; Liotta, Rosa; Gentile, R; Tarantino, Ilaria; Barresi, Luca; Granata, Antonino; Tuzzolino, Fabio; Gridelli, Bruno

doi:10.1016/j.gie.2011.12.005

Cited by 31 publications

(18 citation statements)

References 19 publications

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“…These findings differ from those of a previous study, wherein the addition of aspiration cytology to tissue biopsy did not enhance the diagnostic sensitivity 7. Theoretically, the accuracy of aspiration cytology can be improved by scraping the stricture site prior to aspiration by exposing the subepithelial malignant tissue 6,16,17. Therefore, in the present study, tissue sampling was performed sequentially, and bile aspiration was performed immediately after brush cytology and forceps biopsy.…”

Section: Discussioncontrasting

confidence: 79%

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Triple-Tissue Sampling during Endoscopic Retrograde Cholangiopancreatography Increases the Overall Diagnostic Sensitivity for Cholangiocarcinoma

Lee

et al. 2014

Gut Liver

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Background/AimsThere are several methods for obtaining tissue samples to diagnose malignant biliary strictures during endoscopic retrograde cholangiopancreatography (ERCP). However, each method has only limited sensitivity. This study aimed to evaluate the diagnostic accuracy of a combined triple-tissue sampling (TTS) method (on-site bile aspiration cytology, brush cytology, and forceps biopsy).MethodsWe retrospectively reviewed 168 patients with suspicious malignant biliary strictures who underwent double-tissue sampling (DTS; n=121) or TTS (n=47) via ERCP at our institution from 2004 to 2011.ResultsAmong the 168 patients reviewed, 117 patients (69.6%) were eventually diagnosed with malignancies. The diagnostic sensitivity for cancer was significantly higher in the TTS group than the DTS group (85.0% vs 64.9%, respectively; p=0.022). Furthermore, the combination of brush cytology and forceps biopsy was superior to the other method combinations in the DTS group. With respect to cancer type (cholangiocarcinoma vs noncholangiocarcinoma), interestingly, the diagnostic sensitivity was higher for cholangiocarcinoma in the TTS group than the DTS group (100% vs 69.4%, respectively; p<0.001) but not for the non-cholangiocarcinoma patients (57.1% vs 57.1%, respectively).ConclusionsTTS can provide an improved diagnostic accuracy in suspicious malignant biliary strictures, particularly for cholangiocarcinoma.

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Section: Discussioncontrasting

confidence: 79%

“…Only a few studies have examined the role of bile aspiration cytology in multimodal tissue diagnosis for biliary strictures 7,16. Aspiration cytology is easy to perform and requires minimal effort when combined with other sampling methods.…”

Section: Discussionmentioning

confidence: 99%

Triple-Tissue Sampling during Endoscopic Retrograde Cholangiopancreatography Increases the Overall Diagnostic Sensitivity for Cholangiocarcinoma

Lee

et al. 2014

Gut Liver

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“…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. 36 In patients with negative results on ERCP-guided bile duct biopsy, biopsy sensitivity was improved by the use of intraductal ultrasonography (IDUS)-guided forceps during ERCP. 37 Similarly, cytology or biopsy during PTC has been shown to be effective and safe.…”

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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“…To improve the sensitivity and specificity, many investigators employ various sampling techniques, new devices, the cell block method and molecular methods, such as k-ras point mutation analysis or FISH [7,8,9,10,11,12,13,14,15,16,17,18,19,20]. In some hospitals, to facilitate smear sampling, rapid on-site evaluation is used to prevent air-drying and insufficient sampling [20].…”

Section: Discussionmentioning

confidence: 99%

Brushing Cytology of the Biliary Tract: Bile Juice from the ERCP Sheath Tube Provides Cell-Rich Smear Samples

Wakasa

Inayama²,

Honda³

et al. 2014

Acta Cytologica

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Objectives: To improve the diagnostic accuracy of bile smear cytology, we assessed two cell-yielding procedures. Study Design: One hundred and forty-one patients with biliary stricture underwent endoscopic retrograde cholangiopancreatography (ERCP) and conventional brush sampling. The cytologist cut the brush head off the support wire, centrifuged it directly in tissue culture medium for 1 min at 3,000 rpm, centrifuged the medium again and then smeared the cell pellet onto slides. The remaining sheath tube was then cut into 12-cm segments, which were centrifuged in a centrifuge tube for 1 min at 3,000 rpm, collected and submitted for cytospin preparation. Results: The final histopathological diagnoses based on surgery, biopsy or clinical progression were evaluated for sensitivity, specificity and accuracy. Using conventional smears alone, the sensitivity, specificity and accuracy in patients with biliary stricture were 66.1, 80.7 and 68.8%, respectively. For conventional smears, brush washing and sheath tube contents together, the sensitivity improved to 73.9%, specificity to 100% and accuracy to 78.7%. In the patients with bile duct carcinoma, the sensitivity, specificity and accuracy were 87.3, 100 and 90.7%, respectively. Conclusion: Superior diagnostic accuracy was achieved when conventional smear procedures were combined with the two new procedures.

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Intraductal aspiration: a promising new tissue-sampling technique for the diagnosis of suspected malignant biliary strictures

Cited by 31 publications

References 19 publications

Triple-Tissue Sampling during Endoscopic Retrograde Cholangiopancreatography Increases the Overall Diagnostic Sensitivity for Cholangiocarcinoma

Triple-Tissue Sampling during Endoscopic Retrograde Cholangiopancreatography Increases the Overall Diagnostic Sensitivity for Cholangiocarcinoma

A review of the clinical diagnosis and therapy of cholangiocarcinoma

Brushing Cytology of the Biliary Tract: Bile Juice from the ERCP Sheath Tube Provides Cell-Rich Smear Samples

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