Improving the diagnostic yield of single-operator cholangioscopy-guided biopsy of indeterminate biliary strictures: ROSE to the rescue? (with video)

详细信息    查看全文

• 作者：Shyam Varadarajulu ; MD¹ ; ^&lowast ; ; Ji Young Bang ; MD ; MPH² ; ^&lowast ; ; Muhammad K. Hasan ; MD¹ ; Udayakumar Navaneethan ; MD¹ ; Robert Hawes ; MD¹ ; Shantel Hebert-Magee ; MD¹
• 关键词：CBD ; common bile duct ; EUS-FNA ; EUS-guided FNA ; H&E ; hematoxylin and eosin ; IDBS ; indeterminate biliary stricture ; IPMN ; intraductal papillary mucinous neoplasm ; PSC ; primary sclerosing cholangitis ; ROSE ; rapid onsite evaluation ; SOC ; single-operator cholangioscopy ; TIC ; touch imprint cytology
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：84
• 期：4
• 页码：681-687
• 全文大小：694 K

文摘

Tissue diagnosis, regardless of technique or endoscope used, can be challenging in patients with indeterminate biliary strictures (IDBSs). This exploratory study evaluated the utility and role of rapid onsite evaluation of touch imprint cytology (ROSE-TIC) when single-operator cholangioscopy (SOC)-guided biopsies of IDBSs are performed.

Methods

Patients with IDBSs were evaluated by intraprocedural ROSE-TIC during SOC-guided biopsy procedures. Final diagnosis was established by long-term patient follow-up in conjunction with off-site findings or surgical histology. The main outcome measure was to evaluate the utility of ROSE-TIC by determination of its operating characteristics and comparison with off-site histologic assessment.

Results

Of 31 patients with IDBSs, tissue diagnosis was indeterminate at prior ERCP-guided brush and/or biopsy in 14, prior EUS-guided FNA (EUS-FNA) in 6, and a mass could not be identified at EUS in 11. The mean number of biopsies performed was 3.3 (range 1-8), and diagnostic interpretation by ROSE-TIC was diagnostic and/or suspicious for carcinoma in 15, benign in 13, atypical-reactive in 2, and bile duct intraductal papillary mucinous neoplasm in 1. Final diagnosis by surgical histology (n = 4), death by disease (n = 10), and patient follow-up (n = 17) showed that the overall sensitivity of ROSE-TIC for diagnosing malignancy was 100%, specificity 88.9%, positive predictive value 86.7%, negative predictive value 100%, and diagnostic accuracy 93.5%.

Conclusions

Preliminary data suggest that the diagnostic outcomes of SOC-guided biopsies in IDBSs can be significantly improved by using ROSE-TIC. This technique also may benefit centers that rely mainly on fluoroscopy-guided intraductal biopsies.