Abstract
Background and Aim: Optical coherence tomography (OCT) uses infrared light reflectance to produces high-resolution cross-sectional tissue images. Histology-correlated ex vitro OCT images have identified biliary duct epithelium and subepithelial structures. The aim of this study was to demonstrate the feasibility of biliary intraductal OCT during ERCP and assess the potential of the method to detect malignant biliary strictures. Patients and Methods: A rotating OCT mid focus probe which could be inserted through standard ERCP catheters was used (LightLab, Pentax). The probe generated cross-sectional tissue films of the biliary tract, represented as radial and longitudinal scanning; with 10 μm axial resolution and 1 mm penetration depth. Thirty-two patients were studied during therapeutic ERCP. Biliary strictures had been identified previously. Malignant strictures were defined as those which demonstrated malignant cells in brushing and/or biopsy specimens, and/or EUS-guided FNA and/or surgery. Strictures which did not have malignant cells in resected specimens, or clinical/radiological evidence of disease progression during at least a 12 month follow-up were considered as benign. Two OCT criteria for malignancy were considered: (1) presence of large, non-reflective areas compatible with tumour vessels and (2) unrecognizable layers. Sensitivity and specificity for brushings/biopsies as well as OCT images were calculated. Results: Satisfactory images were obtained from 30 patients; median age: 60 (37-91) years. In two patients, OCT assessment was not performed due to tight strictures. Eighteen patients had malignant and 12 had benign strictures. Malignancy was confirmed by biliary brushings/biopsies in 11/18 (61%) patients. OCT revealed two malignancy criteria in 9/18 (50%) and at least one criterion in 14/18 (77%) patients with malignant strictures. Combining brushings/biopsy with the observation of at least one OCT criterion resulted in the diagnosis of malignancy in 15/18 (83%) patients (Table). There were no complications observed. Conclusions: OCT is feasible during ERCP and may provide information to distinguish between malignant and benign biliary strictures, thus improving the sensitivity and diagnostic accuracy of biliary brushings/biopsies alone. Tabled 1 Brushing/biopsy ≥1 OCT criterion Brushing/biopsy + ≥1 OCT criterion Brushing/biopsy + 2 OCT criteria Sensitivity 11/18 (61%) 14/18 (77%) 15/18 (83%) 14/18 (77%) Specificity 12/12 (100%) 8/12 (67%) 8/12 (66%) 11/12 (92%) Open table in a new tab
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