Improving Diagnostic Yield in Indeterminate Biliary Strictures

Restrepo, David J.; Moreau, Christopher; Edelson, Cyrus; Dev, Ameesh; Saligram, Shreyas; Sayana, Hari; Patel, Sandeep

doi:10.1016/j.cld.2021.08.007

Cited by 2 publications

(2 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding may lead to a more definitive diagnosis. In another study comparing different tissue sampling modalities, forceps biopsy had a significantly higher sensitivity than transpapillary brush cytology, and prior balloon dilatation of the stenosis improved the sensitivity, negative predictive value, and accuracy of forceps biopsy [16]. However, brush cytology, although less invasive, may have limitations in diagnosing biliary strictures, especially when the stricture is patchy or when sample collection is inadequate [17].…”

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy of Brush Cytology and Forceps Biopsy in the Diagnosis of Malignant Biliary Strictures: A Single-Center Study in Pakistan

Khalid,

Qureshi,

Syed

et al. 2024

Preprint

View full text Add to dashboard Cite

IntroductionThe accurate diagnosis of biliary strictures or narrowing of the bile duct is challenging in clinical practice. Differentiating malignant from benign strictures is critical, because these treatments differ considerably. Although noninvasive imaging techniques help identify these strictures, they do not provide definitive tissue diagnosis, making techniques such as brush cytology and forceps biopsy essential. This study aimed to address the dearth of comparative research on the diagnostic efficacy of brush cytology and forceps biopsy in Pakistan.MethodsThis single-center observational study was conducted at the Pakistan Kidney and Liver Institute & Research Center (PKLI&RC), Lahore, from March 2019 to January 2023. Patients with clinically and radiologically suspected biliary strictures were included in the study. Both brush cytology and forceps biopsy samples were subjected to cytopathological analysis by blinded pathologists. Sensitivity, specificity, and predictive values were among the key metrics analyzed.ResultsThe study included 54 patients in the biopsy group and 89 in the brushing group. In terms of diagnostic metrics, the biopsy technique displayed a sensitivity of 65.8%, specificity of 92.3%, positive predictive value (PPV) of 96.4%, and accuracy rate of 72.2%. For the brushing technique, the sensitivity, specificity, PPV, and accuracy were 56.7 %, 93.3%, 83.1%, and 62.9%, respectively. Although both methods showed high specificity, the biopsy technique exhibited a slightly better sensitivity and overall accuracy.ConclusionOur findings underscore the importance of the biopsy method in the accurate diagnosis of malignant biliary strictures, showing marginally superior sensitivity and overall accuracy compared to brush cytology. This knowledge can guide clinicians in Pakistan and similar settings in making informed diagnostic choices to improve patient outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy of Brush Cytology and Forceps Biopsy in the Diagnosis of Malignant Biliary Strictures: A Single-Center Study in Pakistan

Khalid,

Qureshi,

Syed

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Despite clinical symptoms combined with biochemical examinations and medical imaging are effective for diagnosing bile duct enlargement and cholestasis, their abilities to evaluate the etiology of biliary obstruction are largely relied on the presence of tissue lumps. In cases of obstructive jaundice where cross-sectional imaging reveals a stricture unaccompanied by discernible mass lesions—referred to as indeterminate biliary strictures (IBSs)—various invasive technologies have been devised to assist in the characterization of the bile duct stenosis ( 7 ). Tissue sampling by endoscopic retrograde cholangiopancreatography (ERCP) and/or EUS is a mainstay in the evaluation of IBSs.…”

Section: Introductionmentioning

confidence: 99%

Case report: The diagnostic dilemma of indeterminate biliary strictures: report on two cases with a literature review

Meng,

Wang,

Zhang

et al. 2024

Front. Oncol.

View full text Add to dashboard Cite

BackgroundIt is still a challenging problem for clinicians to explore the nature of the indeterminate biliary strictures (IBSs). Approximately 20% of biliary strictures remain undetermined after a thorough preoperative assessment.Case presentationHere, we present two cases of indeterminate biliary strictures patients, whose cross- sectional imaging and endoscopic examination were nondiagnostic. The patients underwent exploratory laparotomy finally and were confirmed as malignancy. We also reviewed the recent reports in literatures regarding the evaluation of IBSs.ConclusionsGiven the majority of the biliary strictures are malignancy, preoperative differentiation between benign and malignant is critical for choosing the best therapeutic regimen. Thus, close follow-up, multiple multidisciplinary discussion, and prompt surgical exploration are necessary for some difficult diagnostic cases.

show abstract

Improving Diagnostic Yield in Indeterminate Biliary Strictures

Cited by 2 publications

References 61 publications

Comparative Efficacy of Brush Cytology and Forceps Biopsy in the Diagnosis of Malignant Biliary Strictures: A Single-Center Study in Pakistan

Comparative Efficacy of Brush Cytology and Forceps Biopsy in the Diagnosis of Malignant Biliary Strictures: A Single-Center Study in Pakistan

Case report: The diagnostic dilemma of indeterminate biliary strictures: report on two cases with a literature review

Contact Info

Product

Resources

About