NDLI: Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study.

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Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Draganov, Peter V. Chauhan, Shailendra Wagh, Mihir S. Gupte, Anand R. Lin, Tong Hou, Wei Forsmark, Chris E.
Description	Country affiliation: United States Author Affiliation: Draganov PV ( Department of Medicine, University of Florida College of Medicine, Gainesville, Florida 32610, USA.)
Abstract	BACKGROUND: The diagnostic accuracy of cholangioscopy-guided sampling has not been rigorously evaluated. OBJECTIVE: To prospectively evaluate the accuracy of cholangioscopy-guided mini-forceps sampling and compare it with standard cytology brushings and forceps biopsies for the tissue diagnosis of indeterminate biliary lesions. DESIGN: Prospective, long-term follow-up, paired design cohort study. SETTING: Tertiary center. PATIENTS: Patients undergoing cholangioscopy for the evaluation of indeterminate biliary lesions. INTERVENTIONS: Each patient underwent triple sampling with cholangioscopy-guided mini-forceps, cytology brushing, and standard forceps. MAIN OUTCOME MEASUREMENTS: Diagnostic accuracy of each sampling method compared with the patient final status (cancer vs no cancer). RESULTS: A total of 26 patients (17 cancer positive/9 cancer negative) were enrolled. The mean follow-up in the patients with no cancer was 21.78 (SD ±6.78) months. The procedure was technically successful in all cases (100%). Sample quality was adequate in 25 of 26 (96.2%) of the cytology brushings, in 26 of 26 (100%) of the standard forceps biopsies, and in 25 of 26 (96.2%) of the mini-forceps biopsies. The sensitivity, accuracy, and negative predictive values were 5.9%, 38.5%, and 36% for standard cytology brushings; 29.4%, 53.8%, and 42.8% for standard forceps biopsies; and 76.5%, 84.6%, and 69.2% for mini-forceps biopsies, respectively. When comparing the 3 methods of sampling, mini-forceps biopsy provided significantly better sensitivity and overall accuracy compared with standard cytology brushing (P < .0001) and standard forceps biopsy (P = .0215). LIMITATIONS: Potential for selection bias. CONCLUSIONS: Cholangioscopy-guided biopsies of indeterminate biliary lesions have significantly higher accuracy compared with ERCP-guided cytology brushings and standard forceps biopsies, but negative findings on mini-forceps biopsy cannot rule out malignancy with a high degree of certainty. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01227382.).
File Format	HTM / HTML
ISSN	00165107
Issue Number	2
Volume Number	75
e-ISSN	10976779
Journal	Gastrointestinal Endoscopy
Language	English
Publisher	Elsevier
Publisher Date	2012-02-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Gastroenterology Bile Duct Neoplasms Pathology Bile Ducts, Intrahepatic Cholangiocarcinoma Cholangiopancreatography, Endoscopic Retrograde Pancreatic Neoplasms Aged Aged, 80 And Over Biopsy Instrumentation Methods Choledochal Cyst Constriction, Pathologic Diagnosis Female Follow-up Studies Humans Male Middle Aged Prospective Studies Sensitivity And Specificity Clinical Trial Journal Article
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Gastroenterology

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