Validation of the diagnostic accuracy of probe-based confocal laser endomicroscopy for the characterization of indeterminate biliary strictures: results of a prospective multicenter international study

Slivka, Adam; Gan, Ian; Jamidar, Priya A.; Costamagna, Guido; Cesaro, Paola; Giovannini, Marc; Caillol, Fabrice; Kahaleh, Michel

doi:10.1016/j.gie.2014.10.009

Cited by 105 publications

(61 citation statements)

References 19 publications

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“…A significant difference has been observed regarding accuracy ( p = 0.0018). Another recent technique has been reported to further increase the sensitivity of cholangioscopy impression and tissue sampling, namely adding probe-based confocal laser endomicroscopy (pCLE) to the diagnostic workup [31, 35, 36]. However, the initial results were not replicated in a recent paper [37], and, therefore, the value of pCLE should be considered with caution, before it is recommended for routine practice.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent review of the literature from 2002 until 2012, including 16 studies and 1,556 patients, biliary brushing cytology was found to be associated with an overall sensitivity of 41.6% and a negative predictive value (NPV) of 58% [23]. To further increase the accuracy of brush cytology, many reports have described different techniques to improve positive yields, including stricture dilatation, repeat brushing, grasp and basket cytology, modified cytology brushes, the cell block method, digital image analysis, and fluorescence in situ hybridization (FISH) [24-31]. These methods all have different success rates, but most of them have increased costs.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Different Methods for Analysis of Biliary Brush Cytology and of Factors Associated with Positive Diagnosis in an Age-Dependent Retrospective Review

Costa

Canena

Mascarenhas-Lemos

et al. 2018

GE Port J Gastroenterol

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Background and Aims: Brush cytology during endoscopic retrograde cholangiopancreatography (ERCP) is the most frequently used strategy for obtaining a tissue sample from an indeterminate biliary stricture. A recent study reported that age is a factor associated with positive yields, but further analysis of how age influences the results was lacking. We aimed to evaluate clinical effectiveness of biliary cytology and prognostic factors for a positive outcome, especially age. Methods: This study was a single-center, retrospective, clinical study of 77 consecutive patients who underwent brush cytology during ERCP to obtain a diagnosis of an indeterminate biliary stricture. We compared 2 routine cytology techniques: A (smear); B (centrifugation of the cytological material collected and the cut-off brush + cell block when sufficient amount of material was available). The data were collected aiming to compare the accuracy of the different techniques used and the prognostic factors affecting the outcome, with a particular focus on age. The yield for brush cytology was compared with the gold standard defined as either definitive histology or the long-term clinical course. Results: The overall accuracy of the 2 used methods was 75.3%. Sensitivity was 52.5%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 66.1%. Although not statistically significant, there was a trend toward accuracy for method B compared with method A (80.4 vs. 65.4%; p = 0.153). Multiple logistic regression analysis showed that younger age was the only independent prognostic factor associated with a positive diagnosis (OR 0.95; 95% CI 0.90–0.99; p = 0.039). Receiver operating characteristic curves for age yielded an area under the curve value of 68.2%. On the basis of the Youden index, 69 years was found to be the optimal cutoff for age. Conclusions: In this series, the accuracy of routine biliary brush cytology was not equal for all methods and ages; in particular, younger patients (below 69 years) tended to have a higher probability of a correct diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of Different Methods for Analysis of Biliary Brush Cytology and of Factors Associated with Positive Diagnosis in an Age-Dependent Retrospective Review

Costa

Canena

Mascarenhas-Lemos

et al. 2018

GE Port J Gastroenterol

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“…8 Efforts to improve the diagnostic sensitivity have included the use of ERCP with fine-needle aspiration (FNA), probe-based confocal laser endomicroscopy (CLE), EUS with FNA, intraductal ultrasound, optical coherence tomography (OCT), and new tissue sampling accessories (including updated biopsy forceps and an endoscopic tissue scraper). [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.…”

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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“…Therefore, pCLE may decrease the number of ERCP needed for diagnosis. 103 Another pCLE study that used the older Miami classification showed accuracy of 81%, sensitivity 98%, and specificity 67% compared to accuracy 75%, sensitivity 45%, and specificity 100% of histopathology. 104 The Paris classification was recently validated for the characterization of indeterminate biliary strictures with increase in specificity, no impact in accuracy and fair interobserver variation (Table 3).…”

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confidence: 99%

“…104 The Paris classification was recently validated for the characterization of indeterminate biliary strictures with increase in specificity, no impact in accuracy and fair interobserver variation (Table 3). [103][104][105][106][107] pCLE was also studied in 15 PSC patients with dominant strictures, some of whom had biliary stents in place, and demonstrated a sufficient stricture visualization of 95%, sensitivity 100%, and specificity 61% in detecting neoplasia. 108 …”

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confidence: 99%

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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Validation of the diagnostic accuracy of probe-based confocal laser endomicroscopy for the characterization of indeterminate biliary strictures: results of a prospective multicenter international study

Cited by 105 publications

References 19 publications

Outcomes of Different Methods for Analysis of Biliary Brush Cytology and of Factors Associated with Positive Diagnosis in an Age-Dependent Retrospective Review

Outcomes of Different Methods for Analysis of Biliary Brush Cytology and of Factors Associated with Positive Diagnosis in an Age-Dependent Retrospective Review

The role and utility of cholangioscopy for diagnosing indeterminate biliary strictures

Comprehensive management of cholangiocarcinoma: Part I. Diagnosis

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