A Novel Method of Forceps Biopsy Improves the Diagnosis of Proximal Biliary Malignancies
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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 double-balloon 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.
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.
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.
KeywordsCholangiocarcinoma Double-balloon enteroscopy Endoscopic retrograde cholangiography
List of Abbreviations
Endoscopic retrograde cholangiography
Endoscopic ultrasonography-guided fine-needle aspiration
Hematoxylin and eosin
Periodic Acid Schiff
Primary sclerosing cholangitis
We would like to thank all the participating patients for making this study possible. Our work was supported by German Research Foundation grants KU 1253/5-3 (H.K.) and STR 1095/2-1 (P.Str.). The technical assistance of Annemarie Schmid is greatly acknowledged.
Conflict of interest
The authors declare that they do not have anything to disclose regarding funding from industries or conflict of interest with respect to this manuscript.