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Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study.
MedLine Citation:
PMID:  22248602     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: The diagnostic accuracy of cholangioscopy-guided sampling has not been rigorously evaluated.
OBJECTIVE: To prospectively evaluate the accuracy of cholangioscopy-guided mini-forceps sampling and compare it with standard cytology brushings and forceps biopsies for the tissue diagnosis of indeterminate biliary lesions.
DESIGN: Prospective, long-term follow-up, paired design cohort study.
SETTING: Tertiary center.
PATIENTS: Patients undergoing cholangioscopy for the evaluation of indeterminate biliary lesions.
INTERVENTIONS: Each patient underwent triple sampling with cholangioscopy-guided mini-forceps, cytology brushing, and standard forceps.
MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy of each sampling method compared with the patient final status (cancer vs no cancer).
RESULTS: A total of 26 patients (17 cancer positive/9 cancer negative) were enrolled. The mean follow-up in the patients with no cancer was 21.78 (SD ±6.78) months. The procedure was technically successful in all cases (100%). Sample quality was adequate in 25 of 26 (96.2%) of the cytology brushings, in 26 of 26 (100%) of the standard forceps biopsies, and in 25 of 26 (96.2%) of the mini-forceps biopsies. The sensitivity, accuracy, and negative predictive values were 5.9%, 38.5%, and 36% for standard cytology brushings; 29.4%, 53.8%, and 42.8% for standard forceps biopsies; and 76.5%, 84.6%, and 69.2% for mini-forceps biopsies, respectively. When comparing the 3 methods of sampling, mini-forceps biopsy provided significantly better sensitivity and overall accuracy compared with standard cytology brushing (P < .0001) and standard forceps biopsy (P = .0215).
LIMITATIONS: Potential for selection bias.
CONCLUSIONS: Cholangioscopy-guided biopsies of indeterminate biliary lesions have significantly higher accuracy compared with ERCP-guided cytology brushings and standard forceps biopsies, but negative findings on mini-forceps biopsy cannot rule out malignancy with a high degree of certainty. (Clinical trial registration number: NCT01227382.).
Authors:
Peter V Draganov; Shailendra Chauhan; Mihir S Wagh; Anand R Gupte; Tong Lin; Wei Hou; Chris E Forsmark
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  75     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  347-53     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
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