Awareness of Tract Seeding With Endoscopic Ultrasound Tissue Acquisition in Perihilar Cholangiocarcinoma

Razumilava, Nataliya; Gleeson, Ferga C.; Gores, Gregory J.

doi:10.1038/ajg.2014.363

Cited by 29 publications

(19 citation statements)

References 5 publications

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“…EUS-guided biliary sampling appears to be safe, with a pooled rate of adverse events of 1 % in the most recent metaanalysis [47]. The main concern is potential tumor seeding that has led some authors to discourage EUS-guided sampling of a hilar mass in locations where liver transplantation is offered for perihilar cholangiocarcinoma (but not sampling of distal lesions as the puncture tract is resected during surgery) [51]. According to these authors, EUS-guided sampling of LNs and other extrahepatic sites remains a very important tool for the staging of perihilar cholangiocarcinoma: in a retrospective study (…”

Section: Biliary Strictures Including Cholangiocarcinomamentioning

confidence: 99%

Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017

et al. 2017

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MAIN RECOMMENDATIONSFor pancreatic solid lesions, ESGE recommends performing endoscopic ultrasound (EUS)-guided sampling as first-line procedure when a pathological diagnosis is required. Alternatively, percutaneous sampling may be considered in metastatic disease.Strong recommendation, moderate quality evidence.In the case of negative or inconclusive results and a high degree of suspicion of malignant disease, ESGE suggests re-evaluating the pathology slides, repeating EUS-guided sampling, or surgery.Weak recommendation, low quality evidence.In patients with chronic pancreatitis associated with a pancreatic mass, EUS-guided sampling results that do not confirm cancer should be interpreted with caution.Strong recommendation, low quality evidence.For pancreatic cystic lesions (PCLs), ESGE recommends EUS-guided sampling for biochemical analyses plus cytopathological examination if a precise diagnosis may change patient management, except for lesions ≤ 10 mm in diameter with no high risk stigmata. If the volume of PCL aspirate is small, it is recommended that carcinoembryonic antigen (CEA) level determination be done as the first analysis.Strong recommendation, low quality evidence.For esophageal cancer, ESGE suggests performing EUS-guided sampling for the assessment of regional lymph nodes (LNs) in T1 (and, depending on local treatment policy, T2) adenocarcinoma and of lesions suspicious for metastasis such as distant LNs, left liver lobe lesions, and suspected peritoneal carcinomatosis.Weak recommendation, low quality evidence.For lymphadenopathy of unknown origin, ESGE recommends performing EUS-guided (or alternatively endobronchial ultrasound [EBUS]-guided) sampling if the pathological result is likely to affect patient management and no superficial lymphadenopathy is easily accessible.Strong recommendation, moderate quality evidence.In the case of solid liver masses suspicious for metastasis, ESGE suggests performing EUS-guided sampling if the pathological result is likely to affect patient management, and (i) the lesion is poorly accessible/not detected at percutaneous imaging, or (ii) a sample obtained via the percutaneous route repeatedly yielded an inconclusive result.Weak recommendation, low quality evidence.

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Section: Biliary Strictures Including Cholangiocarcinomamentioning

confidence: 99%

Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017

et al. 2017

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“…However, for biliary strictures, the value of EUS‐FNA is limited. Although the reported SE for EUS‐FNA is superior to that of brush cytology, FNA is associated with peritoneal seeding of perihilar masses . While each of these techniques has its limitations, ERCP is still the first‐line method of tissue acquisition for diagnosing indeterminate biliary stricture that also enables biliary decompression …”

Section: Discussionmentioning

confidence: 99%

The value of DNA image cytometry combined with brush routine cytology in diagnosing indeterminate biliary strictures: A large sample size retrospective study

Yang

Sun

Guo

et al. 2019

J of Gastro and Hepatol

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Background and Aim:Brush cytology is widely applied to diagnosis indeterminate biliary stricture but suffer from low sensitivity. Changes in DNA content are a character of malignant cell and can be detected by DNA image cytometry (DNA-ICM). The study aimed to estimate the value of routine cytology (RC), DNA-ICM, and their combination in diagnosing indeterminate biliary strictures. Methods: A total of 362 patients who underwent both RC and DNA-ICM tests were analysed. Their results were retrospectively applied to final diagnoses. Diagnostic values were compared among RC, DNA-ICM, and their combination based on the location of strictures. Results: The DNA-ICM and combination of two methods had higher diagnostic accuracy than RC in all strictures (63.3% vs 42.3%, P < 0.001, 64.36% vs 42.3%, P < 0.001) and in distal strictures (65.36% vs 42.81%, P < 0.001, 66.01% vs 42.81%, P < 0.001). But in proximal strictures, DNA-ICM showed no superior (51.8% vs 42.81%, P = 0.184). Combination of two methods was not fully significant superior to RC in proximal strictures (55.36% vs 39.29%, P = 0.089). After classification of "suspicious for malignancy" as positive for malignancy, the diagnostic accuracy of DNA-ICM was still higher than that of RC in all strictures (63.3% vs 51.9%, P = 0.002) and in distal strictures (65.36% vs 52.29%, P = 0.001). Combination of two methods was no superior to DNA-ICM alone (64.36% vs 63.3%, P = 0.757). The utilization of DNA-ICM was more accurate in distal strictures than in proximal strictures (65.36% vs 51.8%, P = 0.017). Conclusion: DNA-ICM is an objective and effective addition tool with RC, especially in distal strictures. The combination of DNA-ICM and RC showed no superior to DNA-ICM alone but could improve diagnostic accuracy to RC in proximal strictures although not fully significant. ) 0.738 (0.625-0.853) † Suspicious cytology findings were considered indications of malignancy.AUC, area under curve; DNA-ICM, DNA image cytometry; NPV, negative predictive value; PPV, positive predictive value; SE, sensitivity; SP, specificity.

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“…LT). 79,80 Evidence for this risk is limited, with one study of 191 patients with CCA that underwent transperitoneal FNA prior to LT to have a higher likelihood of peritoneal metastases versus patients who did not undergo FNA biopsy, 79 while a subsequent retrospective study found that preoperative EUS-FNA in patients with CCA did not affect overall survival. 81 Due to this uncertainty, patients are currently excluded from LT evaluation per the Mayo Clinic protocol if they have undergone EUS-FNA.…”

Section: Initial Evaluation and Surveillance Of Dominant Stricturesmentioning

confidence: 99%

Biliary endoscopy in the management of primary sclerosing cholangitis and its complications

Fung

Tabibian

2019

Liver Research

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Primary sclerosing cholangitis (PSC) is a chronic, idiopathic, cholestatic liver disease characterized by inflammation and fibrosis of the intrahepatic and/or extrahepatic bile ducts. It can affect individuals of all age groups and gender, has no established pharmacotherapy, and is associated with a variety of neoplastic ( e.g. cholangiocarcinoma) and non-neoplastic ( e.g. dominant strictures) hepatobiliary complications. Given these considerations, endoscopy plays a major role in the care of patients with PSC. In this review, we discuss and provide updates regarding endoscopic considerations in the management of hepatobiliary manifestations and complications of PSC. Where evidence is limited, we suggest pragmatic approaches based on currently available data and expert opinion.

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Awareness of Tract Seeding With Endoscopic Ultrasound Tissue Acquisition in Perihilar Cholangiocarcinoma

Cited by 29 publications

References 5 publications

Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017

Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017

The value of DNA image cytometry combined with brush routine cytology in diagnosing indeterminate biliary strictures: A large sample size retrospective study

Biliary endoscopy in the management of primary sclerosing cholangitis and its complications

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