Monocentric study of bile aspiration associated with biliary brushing performed during endoscopic retrograde cholangiopancreatography in 239 patients with symptomatic biliary stricture

Fior‐Gozlan, Michèle; Giovannini, Diane; Rabeyrin, Maud; Leer-Florin, Anne Mc; Laverrière, Marie‐Hélène; Bichard, Philippe

doi:10.1002/cncy.21667

Cited by 18 publications

(14 citation statements)

References 40 publications

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“…In a prospective study of 139 patients, standard biliary brushing before and after stricture dilation with either a dilating catheter or balloon had similar diagnostic sensitivity for suspected malignant biliary strictures, which was not improved significantly even by combination of the results . Intraductal aspiration of bile following brushing for cytology was reported with higher sensitivity than brushing alone in observational studies . In a retrospective study of 168 patients, combining on‐site brush cytology and forceps biopsy followed by bile aspiration cytology (triple‐tissue sampling technique) achieved a higher diagnostic sensitivity than the combination of any 2 of them (double‐tissue sampling) (100% vs 69.4%, P < 0.001) for diagnosing cholangiocarcinoma, but not for other biliary malignancies .…”

Section: Resultsmentioning

confidence: 99%

Review article: Asia‐Pacific consensus recommendations on endoscopic tissue acquisition for biliary strictures

Sun¹,

Lee

Cai

et al. 2018

Aliment Pharmacol Ther

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Section: Resultsmentioning

confidence: 99%

Review article: Asia‐Pacific consensus recommendations on endoscopic tissue acquisition for biliary strictures

Sun¹,

Lee

Cai

et al. 2018

Aliment Pharmacol Ther

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“…It would be interesting to investigate whether ROSE for ERCPguided brushing has even higher accuracy in centers where EUS-FNA is less readily available or is performed by operators with less expertise. Finally, bile intraductal aspiration for collection of additional cytological material was not performed; use of this technique before or after brushing could further increase the diagnostic yield [16,[19][20][21] and may deserve further investigation.…”

Section: Discussionmentioning

confidence: 99%

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

Mariani

Ciambriello²,

Petrone

et al. 2021

Endosc Int Open

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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.

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“…One study tested bile duct aspirate cytology as an adjunct to bile duct brush cytology, improving sensitivity of detecting malignant stricture from 20% to 54%. 15 Another study compared the post-brushing biliary lavage fluid cytology to brush-smear, brush-rinsed saline, and aspirated bile cytology. The post brushing lavage fluid showed the highest sensitivity (70%) as compared to 32%, 43%, and 34%, respectively for the other sampling methods.…”

Section: Discussionmentioning

confidence: 99%

Aspiration fluid cytology during single operator cholangioscopy with targeted biopsy to improves the diagnostic yield in indeterminate biliary strictures

Munot

Raijman

Khan

et al. 2021

Diagnostic Cytopathology

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Introduction Sensitivities of various sampling methods to detect malignant biliary strictures remain suboptimal. Irrigation during digital single operator cholangioscopy (dSOC) is done routinely for visualization of the duct. The aim of this study was to evaluate improvement of the sensitivity for detecting malignant biliary strictures when adding aspiration fluid cytology (AFC) from the irrigated fluid during cholangioscopy to cholangioscopic biopsy (CBx). Methods We conducted a retrospective analysis of patients at a tertiary medical center who underwent CBx for evaluation of their biliary strictures. We included patients who had aspiration of fluid from the bile duct after CBx and were sent for cytology from January 2017 to October 2017. Diagnosis was made on the basis of final pathology or follow‐up over 9 months. Results Fifty‐six patients had CBx obtained, out of which 35 patients had AFC in conjunction. Twenty‐two (62%) patients were male and the average age was 65 years. Considering atypical cells as benign, the sensitivity, specificity, positive and negative predictive values (PPV, NPV) for CBx were 62.5%, 100%, 100%, and 76% respectively. When CBx combined with AFC, the above statistics went up to 81.25%, 100%, 100%, and 86.36% respectively. When atypical cells were considered malignant, the sensitivity, specificity, PPV and NPV for CBx were 81.25%, 84.21%, 81.25%, 84.21% and increased to 93.75%, 78.94%, 78.94%, and 93.75% respectively after adding AFC results. Conclusion For patients with biliary stricture, addition of AFC dSOC guided biopsies, significantly improves the sensitivity for detecting malignancy.

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Monocentric study of bile aspiration associated with biliary brushing performed during endoscopic retrograde cholangiopancreatography in 239 patients with symptomatic biliary stricture

Cited by 18 publications

References 40 publications

Review article: Asia‐Pacific consensus recommendations on endoscopic tissue acquisition for biliary strictures

Review article: Asia‐Pacific consensus recommendations on endoscopic tissue acquisition for biliary strictures

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

Aspiration fluid cytology during single operator cholangioscopy with targeted biopsy to improves the diagnostic yield in indeterminate biliary strictures

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