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EUS-FNA for suspected malignant biliary strictures after negative endoscopic transpapillary brush cytology and forceps biopsy

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Endoscopic transpapillary brush cytology and forceps biopsy are widely used for the pathological diagnosis of suspected malignant biliary strictures (MBS). However, the sensitivity of these methods remains insufficient, and it can be difficult to confirm the diagnosis. We aimed to evaluate the diagnostic ability of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and the impact of this technique on clinical management in patients with suspected MBS where endoscopic brush cytology and biopsy yielded negative results.

Methods

This study included 225 consecutive patients with suspected MBS, who underwent endoscopic brush cytology and biopsy at our institutions. Negative results were obtained for these pathological tests in 75 patients, and EUS-FNA was performed in 22 of these patients. We retrospectively compared the EUS-FNA results with the final diagnosis and examined the influence of the EUS-FNA diagnosis on treatment selection.

Results

FNA specimens were successfully obtained in all patients, and the pathological results confirmed malignancy in 16 cases and predicted that the other 6 cases were benign. Of the 6 cases that were suspected to be benign, 3 patients were diagnosed with xanthogranulomatous cholecystitis by surgical pathology, and the remaining 3 patients were diagnosed with benign diseases at a follow-up after 12–18 months. Thus, the EUS-FNA-based diagnosis was proven correct for all the patients. In addition, the treatment strategy was altered as a result of the EUS-FNA results in the above 6 patients (27%).

Conclusions

EUS-FNA is a sensitive and safe diagnostic modality for patients with suspected MBS and can be an additional option in cases where endoscopic brush cytology and biopsy have produced negative results.

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References

  1. de Bellis M, Sherman S, Fogel EL, Cramer H, Chappo J, McHenry L Jr, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (Part 2). Gastrointest Endosc. 2002;56:720–30.

    Article  PubMed  Google Scholar 

  2. Rosch T, Hofrichter K, Frimberger E, Meining A, Born P, Weigert N, et al. ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc. 2004;60:390–6.

    Article  PubMed  Google Scholar 

  3. Fritscher-Ravens A, Broering DC, Sriram PV, Topalidis T, Jaeckle S, Thonke F, et al. EUS-guided fine-needle aspiration cytodiagnosis of hilar cholangiocarcinoma: a case series. Gastrointest Endosc. 2000;52:534–40.

    Article  PubMed  CAS  Google Scholar 

  4. Fritscher-Ravens A, Broering DC, Knoefel WT, Rogiers X, Swain P, Thonke F, et al. EUS-guided fine-needle aspiration of suspected hilar cholangiocarcinoma in potentially operable patients with negative brush cytology. Am J Gastroenterol. 2004;99:45–51.

    Article  PubMed  CAS  Google Scholar 

  5. Meara RS, Jhala D, Eloubeidi MA, Eltoum I, Chhieng DC, Crowe DR, et al. Endoscopic ultrasound-guided FNA biopsy of bile duct and gallbladder: analysis of 53 cases. Cytopathology. 2006;17:42–9.

    Article  PubMed  CAS  Google Scholar 

  6. Lee JH, Salem R, Aslanian H, Chacho M, Topazian M. Endoscopic ultrasound and fine-needle aspiration of unexplained bile duct strictures. Am J Gastroenterol. 2004;99:1069–73.

    Article  PubMed  Google Scholar 

  7. DeWitt J, Misra VL, Leblanc JK, McHenry L, Sherman S. EUS-guided FNA of proximal biliary strictures after negative ERCP brush cytology results. Gastrointest Endosc. 2006;64:325–33.

    Article  PubMed  Google Scholar 

  8. Byrne MF, Gerke H, Mitchell RM, Stiffler HL, McGrath K, Branch MS, et al. Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions. Endoscopy. 2004;36:715–9.

    Article  PubMed  CAS  Google Scholar 

  9. Eloubeidi MA, Chen VK, Jhala NC, Eltoum IE, Jhala D, Chhieng DC, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of suspected cholangiocarcinoma. Clin Gastroenterol Hepatol. 2004;2:209–13.

    Article  PubMed  Google Scholar 

  10. Hijioka S, Mekky MA, Bhatia V, Sawaki A, Mizuno N, Hara K, et al. Can EUS-guided FNA distinguish between gallbladder cancer and xanthogranulomatous cholecystitis? Gastrointest Endosc. 2010;72:622–7.

    Article  PubMed  Google Scholar 

  11. Yasuda I, Tsurumi H, Omar S, Iwashita T, Kojima Y, Yamada T, et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy for lymphadenopathy of unknown origin. Endoscopy. 2006;38:919–24.

    Article  PubMed  CAS  Google Scholar 

  12. Iwashita T, Yasuda I, Doi S, Kato T, Sano K, Yasuda S, et al. The yield of endoscopic ultrasound-guided fine needle aspiration for histological diagnosis in patients suspected of stage I sarcoidosis. Endoscopy. 2008;40:400–5.

    Article  PubMed  CAS  Google Scholar 

  13. Iwashita T, Yasuda I, Doi S, Nakashima M, Tsurumi H, Hirose Y, et al. Endoscopic ultrasound-guided fine-needle aspiration in patients with lymphadenopathy suspected of recurrent malignancy after curative treatment. J Gastroenterol. 2009;44:190–6.

    Article  PubMed  Google Scholar 

  14. Iwashita T, Yasuda I, Tsurumi H, Goto N, Nakashima M, Doi S, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy for splenic tumor: a case series. Endoscopy. 2009;41:179–82.

    Article  PubMed  CAS  Google Scholar 

  15. Yasuda I, Kato T, Asano F, Okubo K, Omar S, Kako N, et al. Mediastinal lymph node staging in potentially resectable non-small cell lung cancer: a prospective comparison of CT and EUS/EUS-FNA. Respiration. 2009;78:423–31.

    Article  PubMed  Google Scholar 

  16. 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;91:465–7.

    PubMed  CAS  Google Scholar 

  17. Vandervoort J, Soetikno RM, Montes H, Lichtenstein DR, Van Dam J, Ruymann FW, et al. Accuracy and complication rate of brush cytology from bile duct versus pancreatic duct. Gastrointest Endosc. 1999;49:322–7.

    Article  PubMed  CAS  Google Scholar 

  18. Leung JW, Sung JY, Chung SC, Chan KM. Endoscopic scraping biopsy of malignant biliary strictures. Gastrointest Endosc. 1989;35:65–6.

    Article  PubMed  CAS  Google Scholar 

  19. Foutch PG, Kerr DM, Harlan JR, Manne RK, Kummet TD, Sanowski RA. Endoscopic retrograde wire-guided brush cytology for diagnosis of patients with malignant obstruction of the bile duct. Am J Gastroenterol. 1990;85:791–5.

    PubMed  CAS  Google Scholar 

  20. Foutch PG. Diagnosis of cancer by cytologic methods performed during ERCP. Gastrointest Endosc. 1994;40:249–52.

    Article  PubMed  CAS  Google Scholar 

  21. Fogel EL, Sherman S. How to improve the accuracy of diagnosis of malignant biliary strictures. Endoscopy. 1999;31:758–60.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  23. Ponchon T, Gagnon P, Berger F, Labadie M, Liaras A, Chavaillon A, 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;42:565–72.

    Article  PubMed  CAS  Google Scholar 

  24. Kubota Y, Takaoka M, Tani K, Ogura M, Kin H, Fujimura K, et al. Endoscopic transpapillary biopsy for diagnosis of patients with pancreaticobiliary ductal strictures. Am J Gastroenterol. 1993;88:1700–4.

    PubMed  CAS  Google Scholar 

  25. Jailwala J, Fogel EL, Sherman S, Gottlieb K, Flueckiger J, Bucksot LG, et al. Triple-tissue sampling at ERCP in malignant biliary obstruction. Gastrointest Endosc. 2000;51:383–90.

    Article  PubMed  CAS  Google Scholar 

  26. Schoefl R, Haefner M, Wrba F, Pfeffel F, Stain C, Poetzi R, et al. Forceps biopsy and brush cytology during endoscopic retrograde cholangiopancreatography for the diagnosis of biliary stenoses. Scand J Gastroenterol. 1997;32:363–8.

    Article  PubMed  CAS  Google Scholar 

  27. Kitajima Y, Ohara H, Nakazawa T, Ando T, Hayashi K, Takada H, et al. Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures. J Gastroenterol Hepatol. 2007;22:1615–20.

    Article  PubMed  Google Scholar 

  28. Shah JN, Fraker D, Guerry D, Feldman M, Kochman ML. Melanoma seeding of an EUS-guided fine needle track. Gastrointest Endosc. 2004;59:923–4.

    Article  PubMed  Google Scholar 

  29. Paquin SC, Gariepy G, Lepanto L, Bourdages R, Raymond G, Sahai AV. A first report of tumor seeding because of EUS-guided FNA of a pancreatic adenocarcinoma. Gastrointest Endosc. 2005;61:610–1.

    Article  PubMed  Google Scholar 

  30. Doi S, Yasuda I, Iwashita T, Ibuka T, Fukushima H, Araki H, et al. Needle tract implantation on the esophageal wall after EUS-guided FNA of metastatic mediastinal lymphadenopathy. Gastrointest Endosc. 2008;67:988–90.

    Article  PubMed  Google Scholar 

  31. Hirooka Y, Goto H, Itoh A, Hashimoto S, Niwa K, Ishikawa H, et al. Case of intraductal papillary mucinous tumor in which endosonography-guided fine-needle aspiration biopsy caused dissemination. J Gastroenterol Hepatol. 2003;18:1323–4.

    Article  PubMed  Google Scholar 

  32. Takahashi Y, Nagino M, Nishio H, Ebata T, Igami T, Nimura Y. Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. Br J Surg. 2010;97:1860–6.

    Article  PubMed  CAS  Google Scholar 

  33. Smith EH. Complications of percutaneous abdominal fine-needle biopsy. Review. Radiology. 1991;178:253–8.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan

    Yasuhiro Ohshima, Ichiro Yasuda, Tsuyoshi Mukai, Takuji Iwashita, Shinpei Doi, Masanori Nakashima & Hisataka Moriwaki

  2. Department of Gastroenterology, Hokkaido University Hospital, Sapporo, Japan

    Hiroshi Kawakami, Masaki Kuwatani & Masahiro Asaka

  3. Department of Clinical Pathology, Gifu University Hospital, Gifu, Japan

    Yoshinobu Hirose

Authors
  1. Yasuhiro Ohshima
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  2. Ichiro Yasuda
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  3. Hiroshi Kawakami
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Correspondence to Ichiro Yasuda.

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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 46, 921–928 (2011). https://doi.org/10.1007/s00535-011-0404-z

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  • DOI: https://doi.org/10.1007/s00535-011-0404-z

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