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Brush Cytology, Forceps Biopsy, or Endoscopic Ultrasound-Guided Sampling for Diagnosis of Bile Duct Cancer: A Meta-Analysis

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Abstract

Endoscopic sampling is essential for tissue diagnosis of cholangiocarcinoma (CCA). To evaluate and compare the diagnostic sensitivities of endoscopic retrograde cholangiopancreatography-guided brush cytology biopsy, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with CCA. A comprehensive literature search through multiple databases was conducted for articles published between January 1995 and August 2020. The pooled rates of sensitivity for the diagnosis of CCA and of adverse events were compared among brushing, biopsy, brushing & biopsy, and EUS-FNA. In total, 1123 patients with CCA (32 studies), 719 patients (20 studies), 358 patients (13 studies), and 422 patients (17 studies) were tested by brushing, biopsy, brushing & biopsy, and EUS-FNA, respectively. The pooled diagnostic sensitivity was 56.0% (95% confidence interval (CI) 48.8–63.1%, I2 = 83.0%) with brushing, 67.0% (95% CI 60.2–73.5%, I2 = 72.5%) with biopsy, 70.7% (95% CI 64.1–76.8%, I2 = 42.7%) with brushing & biopsy, and 73.6% (95% CI 64.7–81.5%, I2 = 74.7%) with EUS-FNA. The diagnostic sensitivity was significantly lower for brushing than for biopsy, brushing & biopsy, or EUS-FNA. No significant difference was noted in diagnostic sensitivities among biopsy, brushing & biopsy, and EUS-FNA. Adverse events were comparable between the groups. Intraductal biopsy, brushing & biopsy, and EUS-FNA had comparable efficacy and safety for the diagnosis of CCA. Brushing was the least sensitive diagnostic tool compared with intraductal biopsy or EUS-FNA. Given the modest diagnostic sensitivities of intraductal biopsy and EUS-FNA in the diagnosis of CCA, further studies for complementing these techniques with biomarkers may be needed.

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Authors and Affiliations

  1. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Seung Bae Yoon & Sung Woo Ko

  2. Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea

    Sung-Hoon Moon, Hyun Lim, Ho Suk Kang & Jong Hyeok Kim

  3. Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, South Korea

    Sung-Hoon Moon, Hyun Lim, Ho Suk Kang & Jong Hyeok Kim

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Conception and design of the study were contributed by Seung Bae Yoon and Sung-Hoon Moon. Generation, collection, assembly, analysis and/or interpretation of data were contributed by Seung Bae Yoon, Sung-Hoon Moon, Sung Woo Ko, Hyun Lim, and Ho Suk Kang. Drafting of the manuscript was contributed by Seung Bae Yoon and Sung-Hoon Moon. Revision of the manuscript was contributed by Sung Woo Ko, Hyun Lim, Ho Suk Kang, and Jong Hyeok Kim. All authors approved the final version of the manuscript.

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Supplementary Information

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10620_2021_7138_MOESM1_ESM.docx

Supplementary file 1: Table 1. Preferred reporting items for systematic reviews and meta-analyses checklist. (DOCX 27 kb)

Supplementary file 2: Table 2. Study quality assessment. (DOCX 33 kb)

Supplementary file 3: Table 3. Adverse events related with ERCP- and EUS-guided approaches. (DOCX 23 kb)

10620_2021_7138_MOESM4_ESM.docx

Supplementary file 4: Table 4. Comparison of pooled sensitivities of brush cytology, forceps biopsy, and EUS-guided sampling among published meta-analyses. (DOCX 18 kb)

10620_2021_7138_MOESM5_ESM.tif

Supplementary file 5: Fig. 1. Pooled rate of adverse events related with tissue acquisition with (A) ERCP-brush, (B) ERCP-biopsy, and (C) EUS-FNA. (TIF 310 kb)

10620_2021_7138_MOESM6_ESM.tif

Supplementary file 6: Fig. 2. Pooled rate of all adverse events with (A) ERCP-brush, (B) ERCP-biopsy, and (C) EUS-FNA. (TIF 297 kb)

10620_2021_7138_MOESM7_ESM.tif

Supplementary file 7: Fig. 3. Pooled diagnostic sensitivities for cholangiocarcinoma according to the obtained number of specimens (< 4 (A) vs. ≥ 4 (B)). (TIF 233 kb)

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Supplementary file 8: Fig. 4. Pooled odds ratio for diagnostic sensitivity of brushing & biopsy method between CCA and malignant biliary strictures other than CCA patients. CCA, cholangiocarcinoma. (TIF 175 kb)

Supplementary file 9: Fig. 5. Funnel plot of included studies. (TIF 35 kb)

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Yoon, S.B., Moon, SH., Ko, S.W. et al. Brush Cytology, Forceps Biopsy, or Endoscopic Ultrasound-Guided Sampling for Diagnosis of Bile Duct Cancer: A Meta-Analysis. Dig Dis Sci 67, 3284–3297 (2022). https://doi.org/10.1007/s10620-021-07138-4

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  • DOI: https://doi.org/10.1007/s10620-021-07138-4

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