Clin Endosc.  2022 Jul;55(4):549-557. 10.5946/ce.2021.227.

Comparison of tube-assisted mapping biopsy with digital single-operator peroral cholangioscopy for preoperative evaluation of biliary tract cancer

• Takeda T
• Sasaki T
• Mie T
• Okamoto T
• Mori C
• Furukawa T
• Yamada Y
• Kasuga A
• Matsuyama M
• Ozaka M
• Sasahira N

• KMID: 2531949
• DOI: http://doi.org/10.5946/ce.2021.227

Abstract

Background/Aims
Digital single-operator cholangioscopy (DSOC)-guided mapping biopsy (DMB) and tube-assisted mapping biopsy (TMB) are two techniques used for preoperative evaluation of biliary tract cancer (BTC). However, data regarding the diagnostic performance of these techniques are limited.
Methods
We retrospectively examined consecutive patients with BTC who underwent either technique at our institution between 2018 and 2020. We evaluated the technical success rate, adequate tissue acquisition rate, and diagnostic performance of these techniques for the evaluation of lateral spread of BTC.
Results
A total of 54 patients were included in the study. The technical success rate of reaching the target sites was 95% for DMB and 100% for TMB. The adequate tissue acquisition rate was 61% for DMB and 69% for TMB. The adequate tissue acquisition rate was low, especially for target sites beyond the secondary biliary radicles. The sensitivity of DMB alone was 39%, which improved to 65% when combined with visual impression. Experts demonstrated a higher negative predictive value and diagnostic accuracy with respect to both DSOC visual impression and DMB for the evaluation of lateral spread of BTC compared to trainees.
Conclusions
Adequate tissue acquisition rates were similar between the two techniques. Since DMB requires expertise, TMB may be an acceptable option when DSOC is unavailable or when DSOC expertise is limited.

Keyword

Biliary tract neoplasms; Mapping biopsy; Peroral cholangioscopy; Preoperative evaluation; Tube-assisted biopsy

Figure

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  Fig. 1. Mapping biopsy using a biliary stent delivery system (tube-assisted mapping biopsy). (A) A guidewire was advanced into the posterior branch. (B) A 7 Fr-delivery system was inserted into the posterior branch over a guidewire and the pusher catheter remained in the posterior branch after removing the inner catheter and guidewire. A radio-opaque marker was located at the tip of the pusher catheter, which made it easy to adjust the position of the pusher catheter towards the target site. (C) A conventional biopsy forceps with a 1.8-mm diameter cup was advanced through the pusher catheter to the target site under fluoroscopic guidance; biopsy of the posterior branch was performed.

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  Fig. 2. Patient flow chart. DSOC, digital single-operator cholangioscopy; BTC, biliary tract cancer.

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