BACKGROUND & AIMS: Evaluation of indeterminate biliary strictures typically involves collection and analysis of tissue or cells. Single-operator, peroral, cholangioscopic techniques have been developed that allow for a biopsy sample to be obtained from a specific area of the visualized stricture. We investigated whether standard fluoroscopic-guided and cholangioscopic-directed (SpyGlass Direct Visualization System; Boston Scientific, Natick, MA) biopsy collection provide adequate tissue for histologic assessment. METHODS: We examined 110 consecutive bile duct specimens collected from 89 patients with indeterminate biliary strictures at a single institution using fluoroscopy or cholangioscopy (from October 2007 to March 2010). Because of the small nature of the intraductal biopsy fragments, special procedures were followed in the pathology laboratory to maximize the amount of tissue for histopathology analysis. RESULTS: Only 4 specimens (3.6%) had insufficient material for a diagnosis. More tissue was obtained from standard fluoroscopic-guided than cholangioscopic-directed biopsies (more biopsy fragments, P = .018; larger total biopsy size, P = .001). Fluoroscopy-guided biopsies assessed indeterminate biliary strictures with 76% sensitivity and 88% accuracy; these values were 57% and 78%, respectively, for cholangioscopic-directed biopsies. Each procedure had 100% specificity. CONCLUSIONS: Analysis of bile duct biopsies is important in management of patients with indeterminate biliary strictures. Use of a special handling protocol for these small biopsies could reduce the number of cases with insufficient material for diagnosis. Increasing the sample size (either by using larger biopsy forceps or obtaining more biopsy bites) could improve the sensitivity of the SpyGlass technique. As endoscopists and pathologists gain more experience in collecting and handling small biopsies, the diagnostic efficacy of intraductal biopsies will continue to improve.
BACKGROUND & AIMS: Evaluation of indeterminate biliary strictures typically involves collection and analysis of tissue or cells. Single-operator, peroral, cholangioscopic techniques have been developed that allow for a biopsy sample to be obtained from a specific area of the visualized stricture. We investigated whether standard fluoroscopic-guided and cholangioscopic-directed (SpyGlass Direct Visualization System; Boston Scientific, Natick, MA) biopsy collection provide adequate tissue for histologic assessment. METHODS: We examined 110 consecutive bile duct specimens collected from 89 patients with indeterminate biliary strictures at a single institution using fluoroscopy or cholangioscopy (from October 2007 to March 2010). Because of the small nature of the intraductal biopsy fragments, special procedures were followed in the pathology laboratory to maximize the amount of tissue for histopathology analysis. RESULTS: Only 4 specimens (3.6%) had insufficient material for a diagnosis. More tissue was obtained from standard fluoroscopic-guided than cholangioscopic-directed biopsies (more biopsy fragments, P = .018; larger total biopsy size, P = .001). Fluoroscopy-guided biopsies assessed indeterminate biliary strictures with 76% sensitivity and 88% accuracy; these values were 57% and 78%, respectively, for cholangioscopic-directed biopsies. Each procedure had 100% specificity. CONCLUSIONS: Analysis of bile duct biopsies is important in management of patients with indeterminate biliary strictures. Use of a special handling protocol for these small biopsies could reduce the number of cases with insufficient material for diagnosis. Increasing the sample size (either by using larger biopsy forceps or obtaining more biopsy bites) could improve the sensitivity of the SpyGlass technique. As endoscopists and pathologists gain more experience in collecting and handling small biopsies, the diagnostic efficacy of intraductal biopsies will continue to improve.
Authors: Vaidehi Avadhani; Ezgi Hacihasanoglu; Bahar Memis; Burcin Pehlivanoglu; Krisztina Z Hanley; Uma Krishnamurti; Alyssa M Krasinskas; Adeboye O Osunkoya; Lauren M Daniels; Alexa A Freedman; Michael Goodman; Volkan Adsay; Michelle D Reid Journal: Mod Pathol Date: 2017-06-30 Impact factor: 7.842
Authors: Jung Gu Park; Gyoo-Sik Jung; Jong Hyouk Yun; Byung Chul Yun; Sang Uk Lee; Byung Hoon Han; Ji Ho Ko Journal: Eur Radiol Date: 2017-03-27 Impact factor: 5.315
Authors: Johannes Wilhelm Rey; Torsten Hansen; Sebastian Dümcke; Achim Tresch; Katja Kramer; Peter Robert Galle; Martin Goetz; Marcus Schuchmann; Ralf Kiesslich; Arthur Hoffman Journal: World J Gastrointest Endosc Date: 2014-04-16
Authors: Douglas J Hartman; Alyssa M Krasinskas; Shikhar Uttam; Kevin Staton; Rajan Bista; Sumera Rizvi; Adam Slivka; Randall Brand; Yang Liu Journal: Am J Clin Pathol Date: 2014-06 Impact factor: 2.493