A Novel Method of Forceps Biopsy Improves the Diagnosis of Proximal Biliary Malignancies
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Hasan Kulaksiz Pavel Strnad Achim Ro¨mpp Guido von Figura Thomas Barth Irene Esposito Peter Schirmacher Doris Henne-Bruns Guido Adle
- چاپ و سال / کشور: 2011
Description
Background and Aims Tissue specimen collection represents a cornerstone in diagnosis of proximal biliary tract malignancies offering great specificity, but only limited sensitivity. To improve the tumor detection rate, we developed a new method of forceps biopsy and compared it prospectively with endoscopic transpapillary brush cytology. Patients and Methods 43 patients with proximal biliary stenoses, which were suspect for malignancy, undergoing endoscopic retrograde cholangiography were prospectively recruited and subjected to both biopsy [using a doubleballoon enteroscopy (DBE) forceps under a guidance of a pusher and guiding catheter with guidewire] and transpapillary brush cytology. The cytological/histological findings were compared with the final clinical diagnosis. Results 35 out of 43 patients had a malignant disease (33 cholangiocarcinomas, 1 hepatocellular carcinoma, 1 gallbladder carcinoma). The sensitivity of cytology and biopsy in these patients was 49 and 69%, respectively. The method with DBE forceps allowed a pinpoint biopsy of the biliary stenoses. Both methods had 100% specificity, and, when combined, 80% of malignant processes were detected. All patients with non-malignant conditions were correctly assigned by both methods. No clinically relevant complications were observed. Conclusions The combination of forceps biopsy and transpapillary brush cytology is safe and offers superior detection rates compared to both methods alone, and therefore represents a promising approach in evaluation of proximal biliary tract processes
Dig Dis Sci (2011) 56:596–601 DOI 10.1007/s10620-010-1535-4 Received: 30 August 2010 / Accepted: 16 December 2010 / Published online: 8 January 2011
