Clin Endosc.  2018 Mar;51(2):174-180. 10.5946/ce.2017.082.

Usefulness of Endoscopic Transpapillary Tissue Sampling for Malignant Biliary Strictures and Predictive Factors of Diagnostic Accuracy

• Tanaka H
• Matsusaki
• Baba Y
• Isono Y
• Sase T
• Okano H
• Saito T
• Mukai K
• Murata T
• Taoka H

• KMID: 2410985
• DOI: http://doi.org/10.5946/ce.2017.082

Abstract

BACKGROUND/AIMS
It is sometimes difficult to distinguish between malignant and benign biliary strictures using imaging studies alone, and pathological diagnosis is necessary. The aim of this study was to determine the usefulness of endoscopic transpapillary tissue sampling and factors predictive of diagnostic accuracy.
METHODS
From April 2008 to December 2014, 136 patients underwent endoscopic transpapillary tissue sampling for malignant biliary strictures. The cytological and histological findings were reported as negative, suspicious, or positive. Suspicious and positive findings were defined as pathologically positive.
RESULTS
The sensitivity was 65.0% for forceps biopsy, 49.5% for brush cytology, 46.2% for bile aspiration cytology, and 21.9% for endoscopic nasobiliary drainage cytology. The combination of these procedures improved the sensitivity (72.8%). Endoscopic transpapillary tissue sampling was more sensitive for lesions of biliary origin (91.4%) than for extrabiliary lesions (66.3%). In surgical cases, the sensitivity for tumors with an infiltrative growth pattern (53.3%) was significantly lower than for a tumor with an expanding or intermediate growth pattern (87.5%).
CONCLUSIONS
Combining procedures can improve diagnostic accuracy. It may be possible to predict the sensitivity of endoscopic transpapillary tissue sampling by evaluating the etiology and tumor growth pattern using preoperative imaging studies.

Keyword

Biliary tract neoplasms; Pancreatic neoplasms; Endoscopic retrograde cholangiography; Obstructive janudice

MeSH Terms

Bile
Biliary Tract Neoplasms
Biopsy
Constriction, Pathologic*
Diagnosis
Drainage
Humans
Pancreatic Neoplasms
Surgical Instruments

Reference

1. Navaneethan U, Njei B, Lourdusamy V, Konjeti R, Vargo JJ, Parsi MA. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc. 2015; 81:168–176.

2. de Bellis M, Sherman S, Fogel EL, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (part 2). Gastrointest Endosc. 2002; 56:720–730.

3. Lee SJ, Lee YS, Lee MG, Lee SH, Shin E, Hwang JH. Triple-tissue sampling during endoscopic retrograde cholangiopancreatography increases the overall diagnostic sensitivity for cholangiocarcinoma. Gut Liver. 2014; 8:669–673.

4. Jailwala J, Fogel EL, Sherman S, et al. Triple-tissue sampling at ERCP in malignant biliary obstruction. Gastrointest Endosc. 2000; 51(4 Pt 1):383–390.

5. Ponchon T, Gagnon P, Berger F, et al. Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. Gastrointest Endosc. 1995; 42:565–572.

6. Pugliese V, Conio M, Nicolò G, Saccomanno S, Gatteschi B. Endoscopic retrograde forceps biopsy and brush cytology of biliary strictures: a prospective study. Gastrointest Endosc. 1995; 42:520–526.

7. Schoefl R, Haefner M, Wrba F, et al. Forceps biopsy and brush cytology during endoscopic retrograde cholangiopancreatography for the diagnosis of biliary stenoses. Scand J Gastroenterol. 1997; 32:363–368.

8. Kitajima Y, Ohara H, Nakazawa T, et al. Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures. J Gastroenterol Hepatol. 2007; 22:1615–1620.

9. Rösch T, Hofrichter K, Frimberger E, et al. ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc. 2004; 60:390–396.

10. De Bellis M, Sherman S, Fogel EL, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (part 1). Gastrointest Endosc. 2002; 56:552–561.

11. Sugiyama M, Atomi Y, Wada N, Kuroda A, Muto T. Endoscopic transpapillary bile duct biopsy without sphincterotomy for diagnosing biliary strictures: a prospective comparative study with bile and brush cytology. Am J Gastroenterol. 1996; 91:465–467.

12. Logrono R, Kurtycz DF, Molina CP, Trivedi VA, Wong JY, Block KP. Analysis of false-negative diagnoses on endoscopic brush cytology of biliary and pancreatic duct strictures: the experience at 2 university hospitals. Arch Pathol Lab Med. 2000; 124:387–392.

13. Gerritsen A, Molenaar IQ, Bollen TL, et al. Preoperative characteristics of patients with presumed pancreatic cancer but ultimately benign disease: a multicenter series of 344 pancreatoduodenectomies. Ann Surg Oncol. 2014; 21:3999–4006.

14. Abraham SC, Wilentz RE, Yeo CJ, et al. Pancreaticoduodenectomy (Whipple resections) in patients without malignancy: are they all ‘chronic pancreatitis’? Am J Surg Pathol. 2003; 27:110–120.

15. Yagioka H, Hirano K, Isayama H, et al. Clinical significance of bile cytology via an endoscopic nasobiliary drainage tube for pathological diagnosis of malignant biliary strictures. J Hepatobiliary Pancreat Sci. 2011; 18:211–215.

16. Uchida N, Kamada H, Ono M, et al. How many cytological examinations should be performed for the diagnosis of malignant biliary stricture via an endoscopic nasobiliary drainage tube? J Gastroenterol Hepatol. 2008; 23:1501–1504.

17. Kurzawinski T, Deery A, Dooley J, Dick R, Hobbs K, Davidson B. A prospective controlled study comparing brush and bile exfoliative cytology for diagnosing bile duct strictures. Gut. 1992; 33:1675–1677.

18. Abdelghani YA, Arisaka Y, Masuda D, et al. Bile aspiration cytology in diagnosis of bile duct carcinoma: factors associated with positive yields. J Hepatobiliary Pancreat Sci. 2012; 19:370–378.

19. Rabinovitz M, Zajko AB, Hassanein T, et al. Diagnostic value of brush cytology in the diagnosis of bile duct carcinoma: a study in 65 patients with bile duct strictures. Hepatology. 1990; 12(4 Pt 1):747–752.

20. Weilert F, Bhat YM, Binmoeller KF, et al. EUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction: results of a prospective, single-blind, comparative study. Gastrointest Endosc. 2014; 80:97–104.

21. Ohshima Y, Yasuda I, Kawakami H, et al. EUS-FNA for suspected malignant biliary strictures after negative endoscopic transpapillary brush cytology and forceps biopsy. J Gastroenterol. 2011; 46:921–928.

22. Kurihara T, Yasuda I, Isayama H, et al. Diagnostic and therapeutic single-operator cholangiopancreatoscopy in biliopancreatic diseases: prospective multicenter study in Japan. World J Gastroenterol. 2016; 22:1891–1901.

23. Woo YS, Lee JK, Oh SH, et al. Role of SpyGlass peroral cholangioscopy in the evaluation of indeterminate biliary lesions. Dig Dis Sci. 2014; 59:2565–2570.

24. Tieu AH, Kumbhari V, Jakhete N, et al. Diagnostic and therapeutic utility of SpyGlass^® peroral cholangioscopy in intraductal biliary disease: single-center, retrospective, cohort study. Dig Endosc. 2015; 27:479–485.