Dirk Walter1, Jan Peveling-Oberhag2, Falko Schulze3, Dimitra Bon4, Stefan Zeuzem2, Mireen Friedrich-Rust2, Jörg G Albert2. 1. Department of Internal Medicine I, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany(1). Electronic address: dirk.walter@kgu.de. 2. Department of Internal Medicine I, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany(1). 3. Dr Senckenberg Institute for Pathology, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany(2). 4. Institute of Biostatistics and Mathematical Modeling, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany(3).
Abstract
BACKGROUND: Differentiating malignancy from benign disease in indeterminate biliary stricture by imaging modalities is limited. Definite diagnosis relies on histopathological diagnosis. AIMS: To assess accuracy of histopathological diagnosis of fluoroscopy-guided vs. cholangioscopy-directed intraductal biopsies in indeterminate biliary stricture. METHODS: All patients with indeterminate biliary stricture and fluoroscopically (n=68) or cholangioscopy-directed (working channel 2mm, n=38) biopsies were included. Histopathological results of biopsies were classified into inflammatory lesion (class 1), dysplasia/intraepithelial neoplasia (class 2) and malignancy (class 3) and results as well as macroscopic diagnosis were compared with final diagnosis. RESULTS: Sensitivity and specificity of fluoroscopy-guided vs. cholangioscopy-directed biopsies were 22.9% and 100% vs. 25.0% and 100% for class 1+2 vs. class 3 lesions, respectively. Sensitivity for class 1 vs. class 2+3 lesions was 45.7% (p=0.044) vs. 58.3% (p=0.214) for fluoroscopy-guided vs. cholangioscopy-directed biopsies, respectively, while specificity was 100% in both. There was no difference in size of the obtained sample (p=0.992). True positive diagnosis rate increased with the number of biopsies taken (p=0.028). CONCLUSION: Fluoroscopy-guided and cholangioscopy-directed intraductal biopsies are equally limited in establishing the diagnosis of malignancy in indeterminate biliary stricture. Categorizing dysplasia or intraepithelial neoplasia as malignancy increases sensitivity without decrease in specificity. By taking more biopsies, diagnostic yield is increased.
BACKGROUND: Differentiating malignancy from benign disease in indeterminate biliary stricture by imaging modalities is limited. Definite diagnosis relies on histopathological diagnosis. AIMS: To assess accuracy of histopathological diagnosis of fluoroscopy-guided vs. cholangioscopy-directed intraductal biopsies in indeterminate biliary stricture. METHODS: All patients with indeterminate biliary stricture and fluoroscopically (n=68) or cholangioscopy-directed (working channel 2mm, n=38) biopsies were included. Histopathological results of biopsies were classified into inflammatory lesion (class 1), dysplasia/intraepithelial neoplasia (class 2) and malignancy (class 3) and results as well as macroscopic diagnosis were compared with final diagnosis. RESULTS: Sensitivity and specificity of fluoroscopy-guided vs. cholangioscopy-directed biopsies were 22.9% and 100% vs. 25.0% and 100% for class 1+2 vs. class 3 lesions, respectively. Sensitivity for class 1 vs. class 2+3 lesions was 45.7% (p=0.044) vs. 58.3% (p=0.214) for fluoroscopy-guided vs. cholangioscopy-directed biopsies, respectively, while specificity was 100% in both. There was no difference in size of the obtained sample (p=0.992). True positive diagnosis rate increased with the number of biopsies taken (p=0.028). CONCLUSION: Fluoroscopy-guided and cholangioscopy-directed intraductal biopsies are equally limited in establishing the diagnosis of malignancy in indeterminate biliary stricture. Categorizing dysplasia or intraepithelial neoplasia as malignancy increases sensitivity without decrease in specificity. By taking more biopsies, diagnostic yield is increased.
Authors: Lukas Wirsing; Walter Linzenbold; Simon U Jaeger; Phillip Stahl; German Ott; Tobias Leibold; Markus Enderle; Jörg Albert; Jan Peveling-Oberhag Journal: Endosc Int Open Date: 2022-06-10
Authors: Dirk Walter; Sylvia Hartmann; Eva Herrmann; Jan Peveling-Oberhag; Wolf O Bechstein; Stefan Zeuzem; Martin-Leo Hansmann; Mireen Friedrich-Rust; Jörg G Albert Journal: World J Gastroenterol Date: 2017-02-14 Impact factor: 5.742
Authors: Katrin Bankov; Claudia Döring; Markus Schneider; Sylvia Hartmann; Ria Winkelmann; Joerg G Albert; Wolf Otto Bechstein; Stefan Zeuzem; Martin Leo Hansmann; Jan Peveling-Oberhag; Dirk Walter Journal: Clin Transl Gastroenterol Date: 2018-04-30 Impact factor: 4.488