Background and Aims
Malignant biliary strictures can be difficult to diagnose, with up to 20% considered
indeterminate after initial tissue sampling. This study aimed to determine the performance
characteristics of transpapillary biopsy sampling (TPB) and fluorescence in situ hybridization
(FISH) in isolation or in combination with standard brush cytology (BC) in patients
who received trimodality sampling for biliary strictures.
Methods
This single-center retrospective cohort study included patients with biliary strictures
undergoing ERCP with trimodality sampling between September 2014 and April 2019. Performance
characteristics for each diagnostic test alone and in combination were calculated.
Results
Two hundred four patients underwent trimodality biliary sampling, including 104 (51.0%)
with malignancy. The diagnostic sensitivity for malignancy with BC (17.3%) significantly
improved with dual modality (BC+FISH, 58.7%; BC+TPB, 40.4%) or trimodality sampling
(68.3%; P < .001 for all comparisons). Trimodality sampling improved diagnostic sensitivity
for malignancy compared with BC+FISH (P = .002) and BC+TPB (P < .001). There was no statistically significant difference in the sensitivity of
trimodality sampling in detecting cholangiocarcinoma (79.7%) compared with pancreatic
cancer (62.5%; P = .1). Among 57 patients with primary sclerosing cholangitis (PSC), the sensitivity
of detecting biliary malignancy (n = 20) was 20% for BC and significantly improved
with the addition of FISH (80%; P < .001) but not with TPB (35.0%; P = .25). Trimodality sampling did not further improve diagnostic sensitivity (85%)
over BC+FISH (80%) for malignancy in the setting of PSC (P = 1).
Conclusions
Trimodality sampling improves the diagnostic sensitivity for the detection of malignant
biliary strictures with no significant difference in sensitivity for cholangiocarcinoma
compared with pancreatic cancer. However, in patients with PSC, trimodality sampling
was not superior to BC+FISH.
Graphical abstract
Graphical Abstract
Abbreviations:
BC (brush cytology), CCA (cholangiocarcinoma), FISH (fluorescence in situ hybridization), NPV (negative predictive value), PPV (positive predictive value), PSC (primary sclerosing cholangitis), SOC (single-operator cholangioscopy), TPB (transpapillary biopsy sampling)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 02, 2021
Accepted:
November 12,
2021
Received:
August 6,
2021
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: A. C. Storm: Consultant for Olympus, Erbe, GI Dynamics, and Apollo Endosurgery; research support from Apollo Endosurgery, Boston Scientific, and Endo-TAGSS; grant funding from Enterasense. B. K. Abu Dayyeh: Consultant for and research support from Boston Scientific and Medtronic; speaker for Olympus. L. R. Roberts: Advisory board for AstraZeneca, Bayer, Eisai, Exact Sciences, Focus Medical Communications, Gilead Sciences, Grail, Inc, Pontifax, QED Therapeutics, Inc/Helsinn, Roche, and TAVEC; research support from Ariad Pharmaceuticals, Bayer, BTG International/Boston Scientific, Exact Sciences, Fujifilm Medical Systems, Gilead Sciences, Glycotest Inc, RedHill and TARGET PharmaSolutions. B. T. Petersen: Consultant for Olympus America; investigator for Boston Scientific and Ambu. All other authors disclosed no financial relationships.
See CME section, p. 1001.
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© 2022 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
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