Peroral Cholangioscopy-Guided Targeted Biopsy versus Conventional Endoscopic Transpapillary Forceps Biopsy for Biliary Stricture with Suspected Bile Duct Cancer

Abstract

Background: The recent improvement of peroral cholangioscopy (POCS) maneuverability has enabled the precise, targeted biopsy of bile duct lesions under direct cholangioscopic vision. However, as only small-cup biopsy forceps can pass through the scope channel, the resulting small sample size may limit the pathological diagnosis of biopsy specimens. This study compared the diagnostic abilities of POCS-guided biopsy and conventional fluoroscopy-guided biopsy for bile duct cancer. Method: This multicenter, retrospective cohort study included patients exhibiting bile duct stricture with suspected cholangiocarcinoma in whom POCS-guided and fluoroscopy-guided biopsies were performed in the same session. The primary endpoint was the diagnostic sensitivity for malignancy. The size and quality of the biopsy specimens were also compared. Result: A total of 59 patients were enrolled. The sensitivity of POCS-guided biopsy was similar to that of fluoroscopy-guided biopsy (54.0% and 64.0%, respectively). However, when the modalities were combined, the sensitivity increased to 80.0%. The mean specimen size from POCS-guided biopsy was significantly smaller than that from fluoroscopy-guided biopsy. The specimen quality using fluoroscopy-guided biopsy was also better than that using POCS-guided biopsy. Conclusions: The diagnostic sensitivity of POCS-guided biopsy is still insufficient, mainly because of the limited specimen quantity and quality. Therefore, conventional fluoroscopy-guided biopsy would be helpful to improve diagnostic sensitivity.

Accurate and safe diagnosis and treatment of neoplastic biliary lesions using a novel 9F and 11F digital single-operator cholangioscope

“…Advances in POCS devices have improved diagnostic accuracy with targeted biopsies showing 64% to 86% sensitivity and 89% to 100% specificity [9,10,11,12]. Integration of cholangioscopy into brush cytology and fluoroscopyguided biopsies has further enhanced diagnostic sensitivity [13,14]. The Monaco and CRM classifications, based on cholangioscopic findings, have standardized assessments, achieving 70% to 90% diagnostic accuracy with similar interobserver agreement [6,15].…”

Histological evaluation in biliary diseases

“…The addition of fluorescent in situ hybridization (FISH) showed higher sensitivity but reduced specificity for the detection of CCA in PSC, so its utility remains uncertain [39]. SpyGlass cholangioscopy allows targeted biopsies from otherwise inaccessible biliary strictures, Unfortunately, despite its high specificity, the diagnostic sensitivity of the procedure used in isolation remains insufficient [40].…”

A comparison of diagnostic utility of new endoscopic scraper combined cell block method and conventional brush catheter for biliary tract cancer

“…However, the specimens obtained by POCS-FB are usually small, and pathological diagnosis is often difficult. 8 Trefle is a new scraper device for biliary tract tissue collection that enables simultaneous cytological and histological diagnosis,and the diagnostic utility of this device for BTC has recently been reported. [9][10][11][12] As with a conventional brush catheter (CBC), Trefle can be guided to the target biliary stricture over the guidewire.…”

“…Recently, peroral cholangioscopy (POCS) and POCS‐guided forceps biopsy (POCS‐FB) have been used to diagnose malignant biliary lesions. However, the specimens obtained by POCS‐FB are usually small, and pathological diagnosis is often difficult 8 . Trefle is a new scraper device for biliary tract tissue collection that enables simultaneous cytological and histological diagnosis, and the diagnostic utility of this device for BTC has recently been reported 9–12 .…”