Triple modality testing by endoscopic retrograde cholangiopancreatography for the diagnosis of cholangiocarcinoma

Nanda, Arjun; Brown, Jason; Berger, Stephen; Lewis, Melinda M.; Fritcher, Emily G. Barr; Gores, Gregory J.; Keilin, Steven; Woods, Kevin E.; Cai, Qiang; Willingham, Field F.

doi:10.1177/1756283x14564674

Cited by 82 publications

(75 citation statements)

References 48 publications

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“…79,80 Overall, the sensitivity of brush cytology as a single modality of diagnosis is around 55% based on published data. 81,82 Similar findings were reported in the meta-analysis of brush cytology. In the study with 747 patients with PSC-related strictures, it demonstrated sensitivity and specificity of 43% and 97%, respectively.…”

Section: Ercp Ptc Biopsy and Brush Cytologysupporting

confidence: 77%

Comprehensive management of cholangiocarcinoma: Part I. Diagnosis

Papafragkakis

Lee

2017

Int J Gastrointest Interv

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A B S T R A C TCholangiocarcinoma is the second most common primary hepatic malignancy and its incidence is increasing worldwide. Classification and staging of intrahepatic, perihilar, and distal cholangiocarcinomas provide useful prognostic information and further guide in their management. Establishing diagnosis is frequently challenging and may require a multi-modality approach that includes advanced radiological imaging studies and procedures for tissue acquisition; the endoscopic procedures that have been utilized in the management of cholangiocarcinoma comprise endoscopic retrograde cholangiopancreatography with brushing and biopsy, endoscopic ultrasound-guided fine needle aspiration, cholangioscopy with targeted biopsy, and intraductal confocal endomicroscopy. In this review, we will examine the strengths and limitations of each diagnostic tool and assess the serum and bile tumor markers.

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Section: Ercp Ptc Biopsy and Brush Cytologysupporting

confidence: 77%

Comprehensive management of cholangiocarcinoma: Part I. Diagnosis

Papafragkakis

Lee

2017

Int J Gastrointest Interv

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“…Since the sampling area for ductal biopsies is limited, complementary biliary brushings should be considered in all patients. The sensitivity and specificity for the detection of CCA by ductal biopsy in published studies varies from 30-88%, and 97-100%, respectively (106). Combining brush cytology and biopsy has a sensitivity varying from 47-86% and specificity of 97-100%.…”

Section: Ductal Biopsymentioning

confidence: 99%

“…Combining brush cytology and biopsy has a sensitivity varying from 47-86% and specificity of 97-100%. A study (106) assessing the accuracy of triple modality: brush cytology, biopsy and FISH or their combination demonstrated that brush cytology alone had a sensitivity of 42%, specificity of 100%, positive predictive value of 100% and negative predictive value of 88%. Triple sample assessment modality markedly improved the overall sensitivity (82%), specificity (100%), positive predictive value (100%), and negative predictive value (87%).…”

Section: Ductal Biopsymentioning

confidence: 99%

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

Aabakken¹,

Karlsen²,

Albert³

et al. 2017

Journal of Hepatology

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“…[9][10][11][12] Studies have also evaluated fluorescence in situ hybridization (FISH) using probes for genetic alterations associated with CCA, with reported sensitivities ranging from 38% to 58% and specificities between 91% and 100%. 13,14 Newer FISH probes may increase the sensitivity to 65% and next generation genetic sequencing techniques are also promising, but the data is still limited. 15 The sensitivity may increase up to 59% when combining FISH with cytology and up to 82% when combined with both brushing and biopsy.…”

Section: Sampling Of Biliary Pathologymentioning

confidence: 99%

The role and utility of cholangioscopy for diagnosing indeterminate biliary strictures

Thaker

Muthusamy

2017

Int J Gastrointest Interv

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Biliary strictures are considered indeterminate when evaluation with imaging and standard tissue sampling during endoscopic retrograde cholangiopancreatography (ERCP) are non-diagnostic. Standard tissue sampling techniques include cytologic brushings, with or without fluorescence in situ hybridization (FISH), and endoscopic intraductal biopsies. These strictures are often clinically suspicious for malignancy. The management of these patients can vary substantially and relies on an accurate diagnosis of the lesion. Unfortunately, despite numerous modalities, the sensitivity of existing tissue sampling techniques remains low and can lead to delays in diagnosis and the need for additional procedures. Cholangioscopy has emerged as a means to visually inspect and obtain image-guided biopsies of the lesion in question, with improved sensitivity as well as a high specificity and accuracy for diagnosing the etiology of indeterminate biliary strictures. The types of cholangioscopy systems and a summary of the pertinent literature are discussed in this review.

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Triple modality testing by endoscopic retrograde cholangiopancreatography for the diagnosis of cholangiocarcinoma

Abstract: A triple modality approach results in a marked increase in sensitivity for the diagnosis of cholangiocarcinoma compared with single modality testing such as brush cytology and should be considered in the evaluation of indeterminate or suspicious biliary strictures.

Cited by 82 publications

References 48 publications

Comprehensive management of cholangiocarcinoma: Part I. Diagnosis

Comprehensive management of cholangiocarcinoma: Part I. Diagnosis

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

The role and utility of cholangioscopy for diagnosing indeterminate biliary strictures

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