Lipidomic Profiling of Bile in Distinguishing Benign From Malignant Biliary Strictures: A Single-Blinded Pilot Study

Navaneethan, Udayakumar; Gutierrez, Norma G.; Venkatesh, Preethi G.K.; Jegadeesan, Ramprasad; Zhang, Renilang; Jang, Sunguk; Sanaka, Madhusudhan R.; Vargo, John J.; Parsi, Mansour A.; Feldstein, Ariel E.; Stevens, Tyler

doi:10.1038/ajg.2014.60

Cited by 33 publications

(19 citation statements)

References 19 publications

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“…Both techniques are almost 100% specific. With the recent advances in biomarker identification, 38–40 complementing these techniques with serum or biliary tumor markers can further improve the sensitivity and seems to be a reasonable option for enhancing the diagnostic yield.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis

Navaneethan

Njei

Lourdusamy

et al. 2015

Gastrointestinal Endoscopy

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Background Evaluation of indeterminate biliary strictures typically involves collection and analysis of tissue or cells. Brush cytology and intraductal biopsies that are routinely performed during ERCP to assess malignant-appearing biliary strictures are limited by relatively low sensitivity. Objective To study the comparative effectiveness of brushings for cytology and intraductal biopsies in the etiology of biliary strictures. Design Meta-analysis. Setting Referral center. Patients PUBMED and Embase databases were reviewed for studies published to April 2014 where diagnostic correlation of histology was available. Intervention Database and review of study findings. Main Outcome Measurements Sensitivity and specificity. Results The pooled sensitivity and specificity of brushings for the diagnosis of malignant biliary strictures was 45% (95% confidence interval [CI], 40%–50%) and 99% (95% CI, 98%–100%), respectively. The pooled diagnostic odds ratio to detect malignant biliary strictures was 33.43 (95% CI, 14.29–78.24). For intraductal biopsies, the pooled sensitivity and specificity were 48.1% (95% CI, 42.8%–53.4%) and 99.2% (95% CI, 97.6%–99.8%), respectively. The pooled diagnostic odds ratio to detect malignant biliary strictures was 43.18 (95% CI, 19.39–95.83). A combination of both modalities only modestly increased the sensitivity (59.4%; 95% CI, 53.7%–64.8%) with a specificity of 100% (95% CI, 98.8%–100.0%). The Begg-Mazumdar and Egger tests indicated a low potential for publication bias. Limitations Inclusion of low-quality studies. Conclusion Our study suggests that both brushings and biopsy are comparable and have limited sensitivity for the diagnosis of malignant biliary strictures. A combination of both only modestly increases the sensitivity.

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Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis

Navaneethan

Njei

Lourdusamy

et al. 2015

Gastrointestinal Endoscopy

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413

347

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“…In addition to improvement in SpyGlass technology, it is hoped that development of biomarkers in bile in the future will further improve the sensitivity to diagnose CCA. 21,22 …”

Section: Discussionmentioning

confidence: 99%

Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review

Navaneethan¹,

Hasan²,

Lourdusamy³

et al. 2015

Gastrointestinal Endoscopy

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170

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Background and Aims Evaluation of indeterminate biliary strictures by brush cytology and intraductal biopsies is limited by low sensitivity. The utility of SpyGlass peroral cholangioscopy for diagnosis of malignant biliary strictures and cholangiocarcinoma (CCA), in particular, remains unclear. Our aim was to study the utility of SpyGlass peroral cholangioscopy and targeted biopsy for diagnosis of malignant biliary strictures and CCA. Methods In this systematic review, PubMed and Embase databases were reviewed for studies published to October 2014. The main outcomes of interest were sensitivity, specificity, and diagnostic odds ratio (DOR) of SpyGlass cholangioscopy in the diagnosis of malignant biliary strictures. Results The search yielded 10 studies involving 456 patients. The pooled sensitivity and specificity of cholangioscopy-guided biopsies in the diagnosis of malignant biliary strictures was 60.1% (95% confidence interval [CI], 54.9%-65.2%) and 98.0% (95% CI, 96.0%-99.0%), respectively. The pooled DOR to detect malignant biliary strictures was 66.4 (95% CI, 32.1-137.5). Four studies included patients who had previous negative imaging and brushings and/or intraductal biopsies. Among these 4 studies, the pooled sensitivity and specificity for diagnosis of malignant biliary strictures was 74.7% (95% CI, 63.3%-84.0%) and 93.3% (95% CI, 85.1%-97.8%), respectively. The pooled DOR was 46.0 (95% CI, 15.4-138.1). Only 1 study directly compared the yield of SpyBite biopsies with standard brushings and biopsies. SpyBite biopsies had a sensitivity of 76.5% compared with brushings (5.8%) and biopsies (29.4%). Six studies specifically reported the role of cholangioscopy with targeted biopsies in the diagnosis of CCA. The pooled sensitivity and specificity to detect CCA was 66.2% (95% CI, 59.7%-72.3%) and 97.0% (95% CI, 94.0%-99.0%), respectively. The pooled DOR to detect CCA was 79.7 (95% CI, 32.7-194.7). Conclusions Our study suggests that SpyGlass cholangioscopy with SpyBite biopsies has moderate sensitivity for the diagnosis of malignant biliary strictures.

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“…Recently, the SpyGlass system (Boston Scientific Co., Natick, MA, USA) was introduced, which allows for single-operator, direct visualization cholangioscopy for detection and treatment of strictures throughout the pancreatico-biliary system [21]. Even more recently, Nevaneethan et al indicated that the measurement of specific oxidized phospholipids products may help to distinguish cholangiocarcinoma from other biliary strictures, enhancing the endoscopic diagnosis of indeterminate biliary strictures [22].…”

Section: Discussionmentioning

confidence: 99%

Villous adenoma of the common hepatic duct: the importance of contrast-enhanced ultrasound and endoscopic retrograde cholangiopancreatography for relevant diagnosis. A case report and review of the literature

et al. 2015

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Adenomas are frequently encountered in the lower digestive tract but are rarely diagnosed in the biliary tree. We report a case of villous adenoma of the common hepatic duct. A 58-year old male was admitted with a four week history of intermittent upper right quadrant pain. Gray scale and contrast-enhanced abdominal ultrasound showed a mass inside the common hepatic duct with arterial enhancement and slow wash-out during the late venous phase. Subsequent endoscopic retrograde cholangiopancreatography and intraductal ultrasound confirmed the presence of the lesion. The final histopathological examination showed villous adenoma of the common hepatic duct with high-grade dysplasia. Contrast enhanced ultrasonography used in conjecture with endoscopic retrograde cholangiopancreatography can help in differentiating biliary tumors.

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Lipidomic Profiling of Bile in Distinguishing Benign From Malignant Biliary Strictures: A Single-Blinded Pilot Study

Abstract: The measurement of specific oxPL products may help to distinguish CCA from other biliary strictures. Measurement of these products in bile may enhance the endoscopic diagnosis of indeterminate biliary strictures.

Cited by 33 publications

References 19 publications

Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis

Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis

Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review

Villous adenoma of the common hepatic duct: the importance of contrast-enhanced ultrasound and endoscopic retrograde cholangiopancreatography for relevant diagnosis. A case report and review of the literature

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