Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis

Abstract

Background Evaluation of indeterminate biliary strictures typically involves collection and analysis of tissue or cells. Brush cytology and intraductal biopsies that are routinely performed during ERCP to assess malignant-appearing biliary strictures are limited by relatively low sensitivity. Objective To study the comparative effectiveness of brushings for cytology and intraductal biopsies in the etiology of biliary strictures. Design Meta-analysis. Setting Referral center. Patients PUBMED and Embase databases were reviewed for studies published to April 2014 where diagnostic correlation of histology was available. Intervention Database and review of study findings. Main Outcome Measurements Sensitivity and specificity. Results The pooled sensitivity and specificity of brushings for the diagnosis of malignant biliary strictures was 45% (95% confidence interval [CI], 40%–50%) and 99% (95% CI, 98%–100%), respectively. The pooled diagnostic odds ratio to detect malignant biliary strictures was 33.43 (95% CI, 14.29–78.24). For intraductal biopsies, the pooled sensitivity and specificity were 48.1% (95% CI, 42.8%–53.4%) and 99.2% (95% CI, 97.6%–99.8%), respectively. The pooled diagnostic odds ratio to detect malignant biliary strictures was 43.18 (95% CI, 19.39–95.83). A combination of both modalities only modestly increased the sensitivity (59.4%; 95% CI, 53.7%–64.8%) with a specificity of 100% (95% CI, 98.8%–100.0%). The Begg-Mazumdar and Egger tests indicated a low potential for publication bias. Limitations Inclusion of low-quality studies. Conclusion Our study suggests that both brushings and biopsy are comparable and have limited sensitivity for the diagnosis of malignant biliary strictures. A combination of both only modestly increases the sensitivity.

Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA)

“…In this instance, MRI plus magnetic resonance cholangiopancreatography represents the imaging procedure with the highest diagnostic accuracy for localizing and sizing the stricture; thus, the challenge is the definitive demonstration of malignancy [208][209][210][211] . For a definitive diagnosis, these patients usually undergo endoscopic retro grade cholangiopancreatography and a number of procedures (cytology, brushing, FISH (fluorescence in situ hybridization)-polisomy, biopsy, intraductal ultrasono graphy, choledochoscopy, cholangioscopy, chromo endoscopy, confocal endoscopy, narrow-band imaging and so on) can be applied for microscopic confirmation, albeit with unsatisfactory sensitivity [212][213][214][215] . Indeed, at least 40% of patients are sent to surgery without definitive diagnosis and, in 10% of cases after surgery, no evidence of cancer is seen in resected tissues 216 .…”

“…As for iCCA, the risk of tumour seeding after transperitoneal biopsy of pCCA is based on limited evidence 223 . The role of FISH-polisomy in detecting CCA in patients with PSC has been questioned by a meta-analysis, due to its limited sensitivity 215 . Better markers are therefore required for early CCA detection 215 .…”

“…The role of FISH-polisomy in detecting CCA in patients with PSC has been questioned by a meta-analysis, due to its limited sensitivity 215 . Better markers are therefore required for early CCA detection 215 . In this regard, serum CA19-9 levels >130 U/ml in PSC had sensitivity and specificity of 79% and 98% for the detection of CCA, respectively 224 .…”

Utility of lavage cytology plus targeted biopsy during cholangioscopy for the diagnosis of indeterminate biliary lesions

“…Although widely performed, the sensitivity of biliary brush cytology is not sufficiently high, and its accuracy is only 43.0-66.7% [2,3]. The most recent meta-analysis reported that brush cytology for malignant biliary strictures had a sensitivity of 45.0%, specificity of 99.0%, and diagnostic odds ratio (DOR) of 33.43 [3]. Low cellular yields are considered as the primary reason for the low sensitivity of brush cytology.…”

“…A recent meta-analysis determined that transpapillary biopsy for malignant biliary strictures had a sensitivity of 48.1%, specificity of 99.2%, and DOR of 43.18, which were comparable to those of brush cytology [3]. However, combination of brush cytology with transpapillary biopsy increased the sensitivity to 59.4% and the specificity to 100% [3].…”