Endoskopie heute 2010; 23 - FV30
DOI: 10.1055/s-0030-1251650

A combination of endoscopic transpapillary brush cytology and forceps biopsy improves the diagnosis of proximal biliary malignancies- results of a prospective, comparative study

H Kulaksiz 1, P Strnad 1, A Römpp 1, T Barth 2, I Esposito 3, 4, G Adler 1, A Stiehl 5
  • 1Universitätsklinikum Ulm, Klinik für Innere Medizin I, Ulm, Germany
  • 2Universitätsklinikum Ulm, Institut für Pathologie, Ulm, Germany
  • 3Technische Universität München, Institut für Pathologie, München, Germany
  • 4Helmholtz Zentrum München, Institut für Pathologie, Neuherberg, Germany
  • 5Universitätsklinikum Heidelberg, Innere Medizin IV: Gastroenterologie, Infektionskrankheiten, Vergiftungen, Heidelberg, Germany

Background and study aims: Tissue specimen collection represents a cornerstone in diagnosis of proximal biliary tract malignancies offering great specificity, but only limited sensitivity. To improve the tumor detection rate, we developed a new method of forceps biopsy and compared it prospectively with endoscopic transpapillary brush cytology.

Patients and methods: 29 patients with proximal biliary stenoses undergoing endoscopic retrograde cholangiography were prospectively recruited and subjected to both biopsy and transpapillary brush cytology. The cytological/histological findings were compared with the final clinical diagnosis.

Results: 22 patients had a malignant disease (20 cholangiocarcinomas, 1 hepatocellular, 1 galbladder carcinoma). The sensitivity of cytology and biopsy in these patients was 45 and 64%, respectively. Both methods had 100% specificity, and when combined 77% of malignant processes were detected. All patients with non-malignant conditions were correctly assigned by both methods. No clinically relevant complications were observed.

Conclusions: The combination of forceps biopsy and transpapillary brush cytology offers superior detection rates compared to both methods alone and therefore represents a promising approach in evaluation of proximal biliary tract processes.