Format

Send to

Choose Destination
See comment in PubMed Commons below
Gastrointest Endosc. 2006 Sep;64(3):325-33.

EUS-guided FNA of proximal biliary strictures after negative ERCP brush cytology results.

Author information

1
Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.

Abstract

BACKGROUND:

Accurate nonoperative diagnosis of proximal biliary strictures (PBSs) is often difficult.

OBJECTIVE:

To report our experience with EUS-guided FNA (EUS-FNA) of PBSs following negative or unsuccessful results with brush cytology during ERCP.

DESIGN:

Retrospective cohort study.

SETTING:

Single, tertiary referral hospital in Indianapolis, Indiana.

PATIENTS:

Consecutive subjects from January 2001 to November 2004 who underwent EUS-FNA of a PBS documented by ERCP.

INTERVENTIONS:

EUS-FNA of PBS.

MAIN OUTCOME MEASURES:

Performance of EUS-FNA, with the final diagnosis determined by surgical pathology study or the results of EUS-FNA and follow-up.

RESULTS:

A total of 291 biliary strictures undergoing EUS were identified. Of these, 26 (9%) had PBSs and 2 were excluded. EUS-FNA was not attempted in 1 because no mass was visualized. The second had a PBS seen on magnetic resonance cholangiopancreatography, but no ERCP was performed. Twenty-four patients (14 men; mean age, 68 years) underwent EUS-FNA of a PBS following ERCP brush cytology studies that were either negative/nondiagnostic (20) or unable to be performed (4). EUS visualized a mass in 23 (96%) patients, including 13 in whom previous imaging detected no lesion. EUS-FNA (median, 4 passes; range, 1-11) demonstrated malignancy in 17 of 24 (71%) patients with findings showing adenocarcinoma (15), lymphoma (2), atypical cytology (3), or benign cells (4). No complications were noted. Pathology results from 8 of 24 (33%) patients who underwent surgery showed hilar cholangiocarcinoma (6), gallbladder cancer (1), and a benign, inflammatory stricture (1). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 77% (95% confidence interval [CI], 54%-92%), 100% (95% CI, 15%-100%), 100% (95% CI, 83%-100%), 29% (95% CI, 4%-71%), and 79% (95% CI, 58%-93%), respectively.

LIMITATIONS:

Histopathologic correlation of EUS-FNA findings was limited to 8 of 24 (33%) patients who underwent surgery.

CONCLUSIONS:

EUS-FNA is a sensitive method for the diagnosis of PBSs following negative results or unsuccessful ERCP brush cytology. The low negative predictive value does not permit reliable exclusion of malignancy following a negative biopsy.

PMID:
16923477
DOI:
10.1016/j.gie.2005.11.064
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center