Endoscopic Ultrasonography-Guided Fine Needle Aspiration for Extrahepatic Cholangiocarcinoma: A Safe Tissue Sampling Modality.

Takumi Onoyama,Tomoaki Takata,Hiroki Koda,Soichiro Kawata,Yohei Takeda,Kazuya Matsumoto,Hajime Isomoto,Taro Yamashita,Hiroki Kurumi

doi:10.3390/jcm8040417

Takumi Onoyama, Tomoaki Takata + Show 7 more

Open Access

https://doi.org/10.3390/jcm8040417

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Journal: Journal of Clinical Medicine	Publication Date: Mar 27, 2019
Citations: 12	License type: CC BY 4.0

Affiliation: Tottori University

Abstract

Few studies have compared the diagnostic utility of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) tissue sampling for extrahepatic cholangiocarcinoma (ECC). We evaluated the efficacy and safety of EUS-FNA for diagnosing ECC compared with ERCP tissue sampling. Patients who underwent EUS-FNA or ERCP tissue sampling to differentiate ECC from benign biliary disease were enrolled retrospectively between October 2011 and March 2017. We evaluated diagnostic performances of EUS-FNA and ERCP tissue sampling based on pathological evaluation. We compared adverse events in EUS-FNA and ERCP tissue sampling. We enrolled 73 patients with biliary disease and performed EUS-FNA and ERCP in 19 and 54 patients, respectively. Sensitivity, specificity, and accuracy of ERCP tissue sampling were 76.0%, 100%, and 88.9%, respectively, and for EUS-FNA these were 81.8%, 87.5%, and 84.2%, respectively. Statistical values of ERCP tissue sampling and EUS-FNA were not significantly different. The adverse event frequency of EUS-FNA was significantly lower than that of ERCP tissue sampling (0% vs. 25.9%, p = 0.033). The diagnostic ability of EUS-FNA for ECC is similar to that of ERCP tissue sampling. EUS-FNA is a safer tissue sampling modality than ERCP for evaluating biliary disease.

Highlights

Extrahepatic cholangiocarcinoma (ECC) is a poor prognosis disease, with a five-year survival rate of 20.5%, because it is often diagnosed at an advanced stage and is often unresectable [1]
Endoscopic retrograde cholangiopancreatography (ERCP) is a common method for tissue sampling in patients with biliary strictures, using bile aspiration cytology, biliary brush cytology, and forceps biopsy
We examined the diagnostic performance and associated adverse events of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) and ERCP tissue sampling for ECC

Summary

Introduction

Extrahepatic cholangiocarcinoma (ECC) is a poor prognosis disease, with a five-year survival rate of 20.5% (median survival time, 11.3 months), because it is often diagnosed at an advanced stage and is often unresectable [1]. The prognosis of ECC might improve with early diagnosis of ECC [2]. It is often difficult, to differentiate between ECC and benign biliary strictures, such as in primary sclerosing cholangitis, IgG4-associated sclerosing cholangitis, and Mirizzi syndrome. It is important to distinguish ECC from benign biliary disease because the treatment strategies and prognoses differ. Endoscopic retrograde cholangiopancreatography (ERCP) is a common method for tissue sampling in patients with biliary strictures, using bile aspiration cytology, biliary brush cytology, and forceps biopsy. The sensitivities of bile aspiration cytology, brush cytology, and forceps biopsy for biliary strictures are, unsatisfactory in the range of 6%–72% [3,4]

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