Endoscopic Perspective in Cholangiocarcinoma Diagnostic Process

Abstract

Cholangiocarcinoma is a malignancy arising from the epithelial lining of the intrahepatic or extrahepatic biliary tract. Timely diagnosis is challenging due to its silent clinical course. As reliable laboratory markers are lacking, diagnostic imaging plays a pivotal role. While cross-sectional imaging studies are usually conclusive for intrahepatic lesions, endoscopy plays an essential role in cases of extrahepatic tumors. Rational utilization of different diagnostic methods based on available evidence is needed. This article focuses on the diagnostic role of advanced biliary endoscopy, including endoscopic retrograde cholangiopancreatography, cholangioscopy, endoscopic ultrasonography, and intraductal sonography.

Cholangiocarcinoma landscape in Europe: diagnostic, prognostic and therapeutic insights from the ENSCCA Registry

“…73 Endoluminal forceps biopsy has been shown to yield greater sensitivity for the diagnosis of CCA from biliary strictures (74%), 74 but compared to brushing, is technically more challenging and may require sphincterotomy. 71 It is worth noting that a metaanalysis including 9 studies showed pooled sensitivity values of 45% for brushing, 48% for biopsies, and an improvement of up to 59% with the combination of both methods. 75 In order to improve the sensitivity, different technical alternatives have been investigated.…”

“…In addition to imaging approaches, invasive techniques such as endoscopic retrograde cholangiography (ERCP), endoscopic ultrasound (EUS), or cholangioscopy are also performed for the histological diagnosis or high-spatial-resolution imaging. 71 ERCP, based on a combination of luminal endoscopy and fluoroscopic imaging, remains the most commonly used method for cytological/histological confirmation of CCA, with a sensitivity and specificity of 74% and 70%, respectively. 72 It enables the…”

“…acquisition of histological material by: i) bile aspiration, ii) brush cytology, or iii) biopsy with endobiliary forceps. 71 ERCP brushing is currently the standard method used. A meta-analysis including 1,556 patients showed a pooled diagnostic performance of 42%.…”

“…EUS combines both endoscopy with high-frequency sound waves, making possible the detection of masses, bile duct dilatation and the examination of vascular and nodal involvement. 71 Linear EUS scopes provide the ability to perform fine-needle aspiration (FNA), further improving the diagnostic capability. EUS-FNA has shown sensitivity ranging from 43-89% for discerning eCCA from benign biliary lesions, with higher rates described for dCCA.…”

Choledochoscopy: An update

“…Diagnostic accuracy of the preoperative mapping of CCA using choledochoscopy requires further validation, owing to the small sample sizes studied[ 73 ]. In a study by Pereira et al [ 74 ] involving 43 patients, the accuracy of DSOC-guided visual impression and DSOC-guided biopsy was 95% and 81% respectively in the diagnosis of CCA.…”