Combination of ERCP-Based Modalities Increases Diagnostic Yield for Biliary Strictures.
Adenocarcinoma
/ diagnostic imaging
Adult
Aged
Bile Duct Neoplasms
/ diagnostic imaging
Cholangiopancreatography, Endoscopic Retrograde
/ methods
Cholestasis
/ diagnostic imaging
Constriction, Pathologic
/ diagnostic imaging
Cytodiagnosis
/ methods
Female
Humans
In Situ Hybridization, Fluorescence
/ methods
Male
Microscopy, Confocal
/ methods
Middle Aged
Pancreatic Neoplasms
/ diagnostic imaging
Retrospective Studies
Biliary strictures
Cholangioscopy
Confocal laser endomicroscopy
ERCP
Fluorescence in situ hybridization
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
24
12
2019
accepted:
08
05
2020
pubmed:
21
5
2020
medline:
17
8
2021
entrez:
21
5
2020
Statut:
ppublish
Résumé
Biliary stricture evaluation with brush cytology and intraductal forceps biopsy carries a low sensitivity, but the combination of newer modalities may improve sensitivity. To determine whether the addition of advanced modalities increases diagnostic yield of ERCP-based sampling. This single-center retrospective study evaluates patients with biliary strictures sampled using brush cytology. Operating characteristics were calculated for individual and combinations of modalities including cholangioscopy, fluoroscopy- and cholangioscopy-directed intraductal biopsy, fluorescence in situ hybridization (FISH), and confocal laser endomicroscopy. Analyses under Standard Criteria (SC) included malignant results as "positive" and Expanded Criteria (EC) included "suspicious" and "high-grade dysplasia" results as "positive." A total of 614 patients were included, and 354 (57.8%) received brush cytology alone, which had a sensitivity of 38.5% (SC) to 40.3% (EC) and a specificity of 97.8% (EC) to 99.3% (SC). Combining brush cytology with fluoroscopy-guided biopsy (n = 259, 42.2%) had a sensitivity of 62.5% (SC) to 67.9% (EC) and specificity of 90.2% (EC) to 96.7% (SC). Adding FISH to brush cytology had a sensitivity of 84.2% (SC) to 87.5% (EC) and specificity of 54.1% (SC and EC), while cholangioscopy visualization addition resulted in a sensitivity of 80.4% (SC) to 92.2% (EC) and specificity of 67.3% (EC) to 89.1% (SC). There were no significant differences in sensitivity and specificity using SC and EC. Brush cytology has a low sensitivity, but the addition of other modalities increases sensitivity. There was no difference in specificity between the SC and the EC, supporting the inclusion of "suspicious" impressions with malignant results at our center.
Sections du résumé
BACKGROUND
Biliary stricture evaluation with brush cytology and intraductal forceps biopsy carries a low sensitivity, but the combination of newer modalities may improve sensitivity.
AIM
To determine whether the addition of advanced modalities increases diagnostic yield of ERCP-based sampling.
METHODS
This single-center retrospective study evaluates patients with biliary strictures sampled using brush cytology. Operating characteristics were calculated for individual and combinations of modalities including cholangioscopy, fluoroscopy- and cholangioscopy-directed intraductal biopsy, fluorescence in situ hybridization (FISH), and confocal laser endomicroscopy. Analyses under Standard Criteria (SC) included malignant results as "positive" and Expanded Criteria (EC) included "suspicious" and "high-grade dysplasia" results as "positive."
RESULTS
A total of 614 patients were included, and 354 (57.8%) received brush cytology alone, which had a sensitivity of 38.5% (SC) to 40.3% (EC) and a specificity of 97.8% (EC) to 99.3% (SC). Combining brush cytology with fluoroscopy-guided biopsy (n = 259, 42.2%) had a sensitivity of 62.5% (SC) to 67.9% (EC) and specificity of 90.2% (EC) to 96.7% (SC). Adding FISH to brush cytology had a sensitivity of 84.2% (SC) to 87.5% (EC) and specificity of 54.1% (SC and EC), while cholangioscopy visualization addition resulted in a sensitivity of 80.4% (SC) to 92.2% (EC) and specificity of 67.3% (EC) to 89.1% (SC). There were no significant differences in sensitivity and specificity using SC and EC.
CONCLUSIONS
Brush cytology has a low sensitivity, but the addition of other modalities increases sensitivity. There was no difference in specificity between the SC and the EC, supporting the inclusion of "suspicious" impressions with malignant results at our center.
Identifiants
pubmed: 32430658
doi: 10.1007/s10620-020-06335-x
pii: 10.1007/s10620-020-06335-x
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1276-1284Subventions
Organisme : NIGMS NIH HHS
ID : T32 GM007635
Pays : United States
Organisme : NIDDK NIH HHS
ID : T32 DK007038
Pays : United States
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