TY - JOUR
T1 - Impact of trimodality sampling on detection of malignant biliary strictures compared with patients with primary sclerosing cholangitis
AU - Baroud, Serge
AU - Sahakian, Alexander J.
AU - Sawas, Tarek
AU - Storm, Andrew C.
AU - Martin, John A.
AU - Abu Dayyeh, Barham K.
AU - Topazian, Mark D.
AU - Levy, Michael J.
AU - Roberts, Lewis R.
AU - Gores, Gregory J.
AU - Petersen, Bret T.
AU - Chandrasekhara, Vinay
N1 - Funding Information:
DISCLOSURE: The following authors disclosed financial relationships: A. C. Storm: Consultant for Olympus, Erbe, GI Dynamics, and Apollo Endosurgery; research support from Apollo Endosurgery, Boston Scientific, and Endo-TAGSS; grant funding from Enterasense. B. K. Abu Dayyeh: Consultant for and research support from Boston Scientific and Medtronic; speaker for Olympus. L. R. Roberts: Advisory board for AstraZeneca , Bayer, Eisai, Exact Sciences, Focus Medical Communications, Gilead Sciences , Grail, Inc, Pontifax, QED Therapeutics, Inc/Helsinn, Roche, and TAVEC; research support from Ariad Pharmaceuticals , Bayer, BTG International/ Boston Scientific , Exact Sciences, Fujifilm Medical Systems, Gilead Sciences, Glycotest Inc, RedHill and TARGET PharmaSolutions. B. T. Petersen: Consultant for Olympus America; investigator for Boston Scientific and Ambu. All other authors disclosed no financial relationships.
Publisher Copyright:
© 2021 American Society for Gastrointestinal Endoscopy
PY - 2022
Y1 - 2022
N2 - Background and Aims: Malignant biliary strictures can be difficult to diagnose, with up to 20% considered indeterminate after initial tissue sampling. This study aimed to determine the performance characteristics of transpapillary biopsy sampling (TPB) and fluorescence in situ hybridization (FISH) in isolation or in combination with standard brush cytology (BC) in patients who received trimodality sampling for biliary strictures. Methods: This single-center retrospective cohort study included patients with biliary strictures undergoing ERCP with trimodality sampling between September 2014 and April 2019. Performance characteristics for each diagnostic test alone and in combination were calculated. Results: Two hundred four patients underwent trimodality biliary sampling, including 104 (51.0%) with malignancy. The diagnostic sensitivity for malignancy with BC (17.3%) significantly improved with dual modality (BC+FISH, 58.7%; BC+TPB, 40.4%) or trimodality sampling (68.3%; P < .001 for all comparisons). Trimodality sampling improved diagnostic sensitivity for malignancy compared with BC+FISH (P = .002) and BC+TPB (P < .001). There was no statistically significant difference in the sensitivity of trimodality sampling in detecting cholangiocarcinoma (79.7%) compared with pancreatic cancer (62.5%; P = .1). Among 57 patients with primary sclerosing cholangitis (PSC), the sensitivity of detecting biliary malignancy (n = 20) was 20% for BC and significantly improved with the addition of FISH (80%; P < .001) but not with TPB (35.0%; P = .25). Trimodality sampling did not further improve diagnostic sensitivity (85%) over BC+FISH (80%) for malignancy in the setting of PSC (P = 1). Conclusions: Trimodality sampling improves the diagnostic sensitivity for the detection of malignant biliary strictures with no significant difference in sensitivity for cholangiocarcinoma compared with pancreatic cancer. However, in patients with PSC, trimodality sampling was not superior to BC+FISH.
AB - Background and Aims: Malignant biliary strictures can be difficult to diagnose, with up to 20% considered indeterminate after initial tissue sampling. This study aimed to determine the performance characteristics of transpapillary biopsy sampling (TPB) and fluorescence in situ hybridization (FISH) in isolation or in combination with standard brush cytology (BC) in patients who received trimodality sampling for biliary strictures. Methods: This single-center retrospective cohort study included patients with biliary strictures undergoing ERCP with trimodality sampling between September 2014 and April 2019. Performance characteristics for each diagnostic test alone and in combination were calculated. Results: Two hundred four patients underwent trimodality biliary sampling, including 104 (51.0%) with malignancy. The diagnostic sensitivity for malignancy with BC (17.3%) significantly improved with dual modality (BC+FISH, 58.7%; BC+TPB, 40.4%) or trimodality sampling (68.3%; P < .001 for all comparisons). Trimodality sampling improved diagnostic sensitivity for malignancy compared with BC+FISH (P = .002) and BC+TPB (P < .001). There was no statistically significant difference in the sensitivity of trimodality sampling in detecting cholangiocarcinoma (79.7%) compared with pancreatic cancer (62.5%; P = .1). Among 57 patients with primary sclerosing cholangitis (PSC), the sensitivity of detecting biliary malignancy (n = 20) was 20% for BC and significantly improved with the addition of FISH (80%; P < .001) but not with TPB (35.0%; P = .25). Trimodality sampling did not further improve diagnostic sensitivity (85%) over BC+FISH (80%) for malignancy in the setting of PSC (P = 1). Conclusions: Trimodality sampling improves the diagnostic sensitivity for the detection of malignant biliary strictures with no significant difference in sensitivity for cholangiocarcinoma compared with pancreatic cancer. However, in patients with PSC, trimodality sampling was not superior to BC+FISH.
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U2 - 10.1016/j.gie.2021.11.029
DO - 10.1016/j.gie.2021.11.029
M3 - Article
C2 - 34871554
AN - SCOPUS:85123849642
SN - 0016-5107
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
ER -