High sensitivity of ROSE-supported ERCP-guided brushing for biliary strictures

Abstract

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in biliary strictures, with brushing being a cheap and fast method to acquire a cytological specimen, despite a sensitivity around 45 %. Rapid on-site evaluation (ROSE) is widely used for endoscopic ultrasound-acquired cytological specimen adequacy, improving its sensitivity and specificity. Nevertheless, no study has evaluated its role for ERCP-guided brushing. Our aim was to assess the diagnostic yield of ERCP-guided brushing of biliary strictures when supported by ROSE. Patients and methods This was a retrospective single-center study that included patients undergoing ERCP-guided brush cytology supported by ROSE for biliary strictures. Recorded data included patient clinical-radiological and ERCP features. Final diagnosis was determined after surgery, intraductal biopsy or adequate follow-up. The diagnostic yield was calculated and a subgroup analysis for factors associated with false-negative or true-positive results was performed. Results Two hundred six patients were included, 57.3 % males, median age 72 years, 77.2 % having extrahepatic biliary strictures. Of the patients, 99 % had an adequate sample at ROSE after a mean of 2.6 passages. The diagnostic yield was accuracy 83 %, sensitivity 74.6 %, and specificity 98 %, positive and negative predictive values 98 % and 71 % respectively, with an area under the curve of 0.86. A diagnosis of cholangiocarcinoma was significantly more frequent among true-positive cases (68 % vs 46.8 %; P = 0.04). Conclusions This is the first study evaluating the use of ROSE as support for ERCP-guided brushing of biliary strictures, with a sensitivity far higher than those reported for brushing alone and at least comparable to those of more expensive and invasive techniques.

Evaluation of preoperative diagnostic methods for resectable pancreatic cancer: a diagnostic capability and impact on the prognosis of endoscopic ultrasound-guided fine needle aspiration

“…In addition, recently, new needles with unique tip shapes have been utilized in fine needle biopsy (FNB) and have shown higher diagnostic yield with fewer needle passes [25][26][27]. Previously, rapid onsite evaluation (ROSE) has been considered to be effective in improve the diagnostic ability of EUS-FNA, but a recent study could not find any advantages in the diagnostic capability of ROSE during EUS-FNB for pancreatic cancer [28], although ROSE during ERCP-guided brushing for biliary strictures could still be an effective method [29].The overall incidence rate of FNA-related adverse events, such as bleeding, pancreatitis, and peritonitis, has been reported to be very low at 1-2%, and most could be managed conservatively [7,30]. Considering its diagnostic ability and safety, EUS-FNA could be the first-line endoscopic procedure for the preoperative evaluation of suspected pancreatic cancer.…”

ACG Clinical Guideline: Diagnosis and Management of Biliary Strictures

“…However, a meta-analysis published in 2013 comprising 1,556 patients (including 33% with pancreatic cancer and 36% with cholangiocarcinoma) demonstrated a composite sensitivity of brush cytology of only 41.6% (21). Subsequent studies have demonstrated sensitivity rates clustering around 50%–60% (54,55), although notable outliers have reported sensitivities as low as 6% (20) or in the range of 75% (56); however, one of these studies used ROSE of brush cytology specimens (57). Nevertheless, the performance characteristics of this diagnostic modality are inadequate to drive clinical decision making, and thus, additional sampling techniques are now commonly performed.…”

Observation for the feasibility of a bile duct biopsy technique using a loop-tip guidewire during endoscopic retrograde cholangiopancreatography

“…[ 3 ] In a recent study, the sensitivity of brush cytology was found to be higher, at 74.6%, with the help of rapid on-site evaluation, but it is difficult to generalize these results because the number of institutions equipped for conducting rapid on-site evaluation are limited. [ 4 ]…”

“…[3] In a recent study, the sensitivity of brush cytology was found to be higher, at 74.6%, with the help of rapid on-site evaluation, but it is difficult to generalize these results because the number of institutions equipped for conducting rapid on-site evaluation are limited. [4] Some advantages of the biopsy method include a higher diagnostic rate and negative predictive value compared with those of the brush cytology method. [5] Although forceps biopsy is a commonly performed procedure with these advantages, if the location of the stricture cannot be easily approached with biopsy forceps, endoscopists may find this technique difficult.…”