PDF herunterladen
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
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

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



Publikationsverlauf

Eingereicht: 02. Februar 2020

Angenommen: 05. Juni 2020

Artikel online veröffentlicht:
21. Oktober 2020

© 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

 

  • References

  • 1 Patel T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology 2001; 33: 1353-1357
    CrossrefPubMedGoogle Scholar
  • 2 Taylor-Robinson SD, Toledano MB, Arora S. et al. Increase in mortality rates from intrahepatic cholangiocarcinoma in England and Wales 1968-1998. Gut 2001; 48: 816-820
    CrossrefPubMedGoogle Scholar
  • 3 Patel AH, Harnois DM, Klee GG. et al. The utility of CA 19-9 in the diagnoses of cholangiocarcinoma in patients without primary sclerosing cholangitis. Am J Gastroenterol 2000; 95: 204-207
    CrossrefPubMedGoogle Scholar
  • 4 Clayton RAE, Clarke DL, Currie EJ. et al. Incidence of benign pathology in patients undergoing hepatic resection for suspected malignancy. Surgeon 2003; 1: 32-38
    CrossrefPubMedGoogle Scholar
  • 5 Fritscher-Ravens A, Broering DC, Knoefel WT. 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
    CrossrefPubMedGoogle Scholar
  • 6 Gerhards MF, Vos P, van Gulik TM. et al. Incidence of benign lesions in patients resected for suspicious hilar obstruction. Br J Surg 2001; 88: 48-51
    CrossrefPubMedGoogle Scholar
  • 7 Uhlmann D, Wiedmann M, Schmidt F. et al. Management and outcome in patients with Klatskin-mimicking lesions of the biliary tree. J Gastrointest Surg 2006; 10: 1144-1150
    CrossrefPubMedGoogle Scholar
  • 8 Nakayama A, Imamura H, Shimada R. et al. Proximal bile duct stricture disguised as malignant neoplasm. Surgery 1999; 125: 514-521
    CrossrefPubMedGoogle Scholar
  • 9 Wetter LA, Ring EJ, Pellegrini CA. et al. Differential diagnosis of sclerosing cholangiocarcinomas of the common hepatic duct (Klatskin tumors). Am J Surg 1991; 161: 57-62 ; discussion 62–63
    CrossrefPubMedGoogle Scholar
  • 10 DeWitt J, Misra VL, LeBlanc JK. et al. EUS-guided FNA of proximal biliary strictures after negative ERCP brush cytology results. Gastrointest Endosc 2006; 64: 325-333
    CrossrefPubMedGoogle Scholar
  • 11 Selvaggi SM. Biliary brushing cytology. Cytopathology 2004; 15: 74-79
    CrossrefPubMedGoogle Scholar
  • 12 Khashab MA, Fockens P, Al-Haddad MA. Utility of EUS in patients with indeterminate biliary strictures and suspected extrahepatic cholangiocarcinoma (with videos). Gastrointest Endosc 2012; 76: 1024-1033
    CrossrefPubMedGoogle Scholar
  • 13 Hammoud GM, Almashhrawi A, Ibdah JA. Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of hepatic, gallbladder and biliary tract Lesions. World J Gastrointest Oncol 2014; 6: 420-429
    CrossrefPubMedGoogle Scholar
  • 14 Cannon ME, Carpenter SL, Elta GH. et al. EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc 1999; 50: 27-33
    CrossrefPubMedGoogle Scholar
  • 15 Brais RJ, Davies SE, O’Donovan M. et al. Direct histological processing of EUS biopsies enables rapid molecular biomarker analysis for interventional pancreatic cancer trials. Pancreatology 2012; 12: 8-15
    CrossrefPubMedGoogle Scholar
  • 16 Pitman MB, Layfield LJ. Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: A review. Cancer Cytopathol 2014; 122: 399-411
    CrossrefPubMedGoogle Scholar
  • 17 R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing; 2014 Available at: https://www.R-project.org/
    PubMedGoogle Scholar
  • 18 Baron TH, Mallery JS, Hirota WK. et al. The role of endoscopy in the evaluation and treatment of patients with pancreaticobiliary malignancy. Gastrointest Endosc 2003; 58: 643-649
    CrossrefPubMedGoogle Scholar
  • 19 Eloubeidi MA, Chen VK, Jhala NC. et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of suspected cholangiocarcinoma. Clin Gastroenterol Hepatol 2004; 2: 209-213
    CrossrefPubMedGoogle Scholar
  • 20 Meara RS, Jhala D, Eloubeidi MA. et al. Endoscopic ultrasound-guided FNA biopsy of bile duct and gallbladder: analysis of 53 cases. Cytopathology 2006; 17: 42-49
    CrossrefPubMedGoogle Scholar
  • 21 Lee JH, Salem R, Aslanian H. et al. Endoscopic ultrasound and fine-needle aspiration of unexplained bile duct strictures. Am J Gastroenterol 2004; 99: 1069-1073
    Google Scholar
  • 22 Williams DB, Sahai AV, Aabakken L. et al. Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience. Gut 1999; 44: 720-726
    CrossrefPubMedGoogle Scholar
  • 23 Fritscher-Ravens A, Broering DC, Sriram PV. et al. EUS-guided fine-needle aspiration cytodiagnosis of hilar cholangiocarcinoma: a case series. Gastrointest Endosc 2000; 52: 534-540
    CrossrefPubMedGoogle Scholar
  • 24 Ranney N, Phadnis M, Trevino J. et al. Impact of biliary stents on EUS-guided FNA of pancreatic mass lesions. Gastrointest Endosc 2012; 76: 76-83
    CrossrefPubMedGoogle Scholar
  • 25 Mohamadnejad M, DeWitt JM, Sherman S. et al. Role of EUS for preoperative evaluation of cholangiocarcinoma: a large single-center experience. Gastrointest Endosc 2011; 73: 71-78
    Google Scholar
  • 26 Sai JK, Suyama M, Kubokawa Y. et al. Early detection of extrahepatic bile-duct carcinomas in the nonicteric stage by using MRCP followed by EUS. Gastrointest Endosc 2009; 70: 29-36
    CrossrefPubMedGoogle Scholar
  • 27 Sadeghi A, Mohamadnejad M, Islami F. et al. Diagnostic yield of EUS-guided FNA for malignant biliary stricture: a systematic review and meta-analysis. Gastrointest Endosc 2016; 83: 290-298.e1
    CrossrefPubMedGoogle Scholar
  • 28 Levy MJ, Baron TH, Clayton AC. et al. Prospective evaluation of advanced molecular markers and imaging techniques in patients with indeterminate bile duct strictures. Am J Gastroenterol 2008; 103: 1263-1273
    CrossrefPubMedGoogle Scholar
  • 29 Poropat G, Giljaca V, Stimac D. et al. Bile acids for primary sclerosing cholangitis. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2011
    CrossrefGoogle Scholar
  • 30 Shi J, Li Z, Zeng X. et al. Ursodeoxycholic acid in primary sclerosing cholangitis: meta-analysis of randomized controlled trials. Hepatol Res 2009; 39: 865-873
    CrossrefPubMedGoogle Scholar
  • 31 Micames C, Jowell PS, White R. et al. Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA. Gastrointest Endosc 2003; 58: 690-695
    CrossrefPubMedGoogle Scholar
  • 32 Ikezawa K, Uehara H, Sakai A. et al. Risk of peritoneal carcinomatosis by endoscopic ultrasound-guided fine needle aspiration for pancreatic cancer. J Gastroenterol 2013; 48: 966-972
    CrossrefPubMedGoogle Scholar
  • 33 Kim SH, Woo YS, Lee KH. et al. Preoperative EUS-guided FNA: effects on peritoneal recurrence and survival in patients with pancreatic cancer. Gastrointest Endosc 2018; 88: 926-934
    CrossrefPubMedGoogle Scholar
  • 34 El Chafic AH, DeWitt JM, Sherman S. et al. Mo1375 preoperative endoscopic ultrasound-fine needle aspiration (EUS-FNA): impact on long-term outcomes for cholangiocarcinoma (CCA). Gastrointest Endosc 2011; 73: AB323-AB324
    CrossrefPubMedGoogle Scholar
  • 35 Gleeson FC, Lee JH, Dewitt JM. Tumor seeding associated with selected gastrointestinal endoscopic interventions. Clin Gastroenterol Hepatol 2018; 16: 1385-1388
    CrossrefPubMedGoogle Scholar
  • 36 Chapman MH, Thorburn D, Hirschfield GM. et al. British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis. Gut 2019; 68: 1356-1378
    CrossrefPubMedGoogle Scholar