Endoscopic Ultrasound Plus Endoscopic Retrograde Cholangiopancreatography Based Tissue Sampling for Diagnosis of Proximal and Distal Biliary Stenosis Due to Cholangiocarcinoma: Results from a Retrospective Single-Center Study

Abstract

Differentiating between benign and malignant biliary stenosis (BS) is challenging, where tissue diagnosis plays a crucial role. Endoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling and endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) or biopsy (FNB) are used to obtain tissue specimens from BS. The aim of this retrospective study was to evaluate the diagnostic yield of EUS-FNA/B plus ERCP with brushing or forceps biopsy in BS. All endoscopic procedures performed in patients with BS at our gastroenterology unit were reviewed. The gold standard for diagnosis was histopathology of surgical specimens or the progression of the malignancy at radiological or clinical follow-up. A total of 70 endoscopic procedures were performed in 51 patients with BS. Final endoscopic diagnosis was reached in 96% of the patients and was malignant in 61.7% and benign in 38.3% of cases. Sensitivity, specificity, and diagnostic accuracy were 73.9%, 100%, and 80%, respectively, for EUS-FNA/B; 66.7%, 100%, and 82.5% for ERCP; and 83.3%, 100%, and 87.5% for both procedures carried out in the same session. The combination of EUS and ERCP tissue sampling seems to increase diagnostic accuracy in defining the etiology of BS. Performing both procedures in a single session reduces the time required for diagnostic work-up and optimizes resources.

Endoscopic Ultrasound in the Diagnosis of Extrahepatic Cholangiocarcinoma: What Do We Know in 2023?

“…Currently, there are no conclusive data regarding the use of EUS-FNB in CCA. A study by Troncone et al pointed out that EUS-FNA/FNB has a sensitivity, specificity, and diagnostic accuracy of 73.9, 100, and 80%, respectively [ 75 ]. For distal biliary stenosis, the sensitivity and accuracy of EUS-FNA/B were 44.4 and 64.3% respectively, increasing to 90.1 and 91.7% in the case of proximal biliary stenosis [ 75 ].…”

“…A study by Troncone et al pointed out that EUS-FNA/FNB has a sensitivity, specificity, and diagnostic accuracy of 73.9, 100, and 80%, respectively [ 75 ]. For distal biliary stenosis, the sensitivity and accuracy of EUS-FNA/B were 44.4 and 64.3% respectively, increasing to 90.1 and 91.7% in the case of proximal biliary stenosis [ 75 ]. As found in a retrospective study, the size of needles (22 vs. 25G vs. 19G) did not influence the diagnostic rate (70.9 vs. 75.3 vs. 66.7%), and complications such as bleeding have been rarely reported [ 36 , 78 ].…”

Artificial intelligence in medical imaging for cholangiocarcinoma diagnosis: A systematic review with scientometric analysis

“…4 While imaging with endoscopic ultrasonography (EUS), computerized tomography (CT), positron emission tomography (PET), magnetic resonance imaging/cholangiopancreatography (MRI/MRCP), and cholangioscopy plays a key role in the diagnosis and management of CCA, the diagnostic yield of current imaging modalities for CCA remains suboptimal. 5,[11][12][13][14][15] In a meta-analysis of 21 studies, single-operator cholangioscopy with targeted biopsies was the most accurate diagnostic imaging modality for cholangiocarcinoma among patients with PSC-induced biliary strictures, despite having a modest sensitivity of 65% (95% CI, 35-87%). 16 Artificial intelligence (AI) is a branch of computer science that uses computational methods to simulate human intelligence.…”