CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(11): E1537-E1544
DOI: 10.1055/a-1231-4948
Original article

Test performance and predictors of accuracy of endoscopic ultrasound-guided fine-needle aspiration for diagnosing biliary strictures or masses

Tim Raine
1  Division of Gastroenterology, Department of Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
,
John P. Thomas
2  Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich, UK
,
Rebecca Brais
3  Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
,
Edmund Godfrey
4  Department of Endoscopy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
,
Nicholas R. Carroll
4  Department of Endoscopy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
,
Andrew J. Metz
5  Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
› Author Affiliations
  

Abstract

Background and study aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has emerged as an important method for obtaining a preoperative tissue diagnosis for suspected cholangiocarcinoma. However, doubts remain about test sensitivity. This study assessed the value and limitations of EUS-FNA in clinical practice.

Patients and methods Patients undergoing EUS-FNA for biliary strictures/masses at a UK tertiary referral center from 2005 to 2014 were prospectively enrolled. Data on EUS-FNA findings, histology, and endoscopy and patient outcomes were collected to evaluate test performance and identify factors predictive of an inaccurate diagnostic result.

Results Ninety-seven patients underwent a total of 112 EUS-FNA procedures. Overall test sensitivity for an initial EUS-FNA for suspected cholangiocarcinoma was 75 % (95 % CI 64 %–84 %), with specificity 100 % (95 % CI 85 %–100 %) and negative predictive value 0.62 (95 % CI 0.47–0.75). Hilar lesions, the presence of a biliary stent, and a diagnosis of PSC were significantly independently associated with an inaccurate result. For the most difficult cases, repeat sampling and use of the Papanicolaou cytopathology grading scale led to an increase in test sensitivity from 17 % to 100 % (P = 0.015) with no loss of specificity.

Conclusions EUS-FNA was found to be a useful method for obtaining a preoperative tissue diagnosis for patients with suspected cholangiocarcinoma. This study identified markers that can reduce test accuracy and measures that can improve test performance of EUS-FNA.

Supplementary material



Publication History

Received: 02 February 2020

Accepted: 05 June 2020

Publication Date:
21 October 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany