Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-1897-4686
Histological assessment of new cholangioscopy-guided forceps in ERCP biliary stricture sampling: a blinded comparative study
![](https://www.thieme-connect.de/media/10.1055-s-00025476/202209/lookinside/thumbnails/2604_10-1055-a-1897-4686-1.jpg)
Abstract
Background and study aims Obtaining quality tissue during ERCP biliary stricture sampling is of paramount importance for a timely diagnosis. While single-operator cholangioscopy (SOC)-guided biopsies have been suggested to be the superior biliary tissue acquisition modality given direct tissue visualization, less is known about the specimen histological quality. We aimed to analyze the specimen quality of SOC biopsies and compare the new generation forceps with prior “legacy” forceps.
Patients and methods Patients who underwent SOC from January 2017-August 2021 for biliary sampling were reviewed. In February 2020, the SOC-guided biopsy forceps were changed from legacy SpyBite to the SpyBite Max forceps (max). Specimens were assessed by blinded pathologists for crush artifact (none, mild, or severe) and gross size (greatest dimension in mm). Crush artifact and gross size were compared between the two groups. The diagnostic performance characteristics for cholangiocarcinoma (CCA), were assessed in an exploratory fashion.
Results Eighty-one patients (max = 27, legacy = 54) with similar baseline characteristics were included in this study. On blinded pathological assessment, 58 % had crush artifact, without significant differences between the two groups (Max 63 % vs. Legacy 56 %; P = 0.64). A similar mean specimen size was found (max 3 mm vs. legacy 3.2 mm; P = 0.24). The overall prevalence of CCA was 40 %. The sensitivity, specificity, positive predictive value, and negative predictive value of the entire cohort using a combination of cytology, fluorescence in situ hybridization, and SOC-guided biopsies were 78.1 %, 91.8 %, 86.2 %, and 86.5 %, respectively. No difference between legacy or max groups was found.
Conclusions A high rate of crush artifact was found in SOC-guided biopsy specimens. Further investigation regarding proper biopsy technique and handling is necessary to increase the diagnostic yield with SOC-guided biopsies.
Publication History
Received: 03 December 2021
Accepted after revision: 24 June 2022
Article published online:
14 September 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Petersen BT. The management of biliary strictures. Dig Endosc 2012; 24: 67-70
- 2 Rabinovitz M, Zajko AB, Hassanein T. et al. Diagnostic value of brush cytology in the diagnosis of bile duct carcinoma: A study in 65 patients with bile duct strictures. Hepatology 1990; 12: 747-752
- 3 Foutch PG, Kerr DM, Harlan JR. et al. A prospective, controlled analysis of endoscopic cytotechniques for diagnosis of malignant biliary strictures. Am J Gastroenterol 1991; 86: 577-580
- 4 Kurzawinski TR, Deery A, Dooley JS. et al. A prospective study of biliary cytology in 100 patients with bile duct strictures. Hepatology 1993; 18: 1399-1403
- 5 Ponchon T, Gagnon P, Berger F. et al. Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. Gastrointest Endosc 1995; 42: 565-572
- 6 Pugliese V, Conio M, Nicolo G. et al. Endoscopic retrograde forceps biopsy and brush cytology of biliary strictures: a prospective study. Gastrointest Endosc 1995; 42: 520-526
- 7 Navaneethan U, Njei B, Venkatesh PG. et al. Fluorescence in situ hybridization for diagnosis of cholangiocarcinoma in primary sclerosing cholangitis: a systematic review and meta-analysis. Gastrointest Endosc 2014; 79: 943-950.e3
- 8 Trikudanathan G, Navaneethan U, Njei B. et al. Diagnostic yield of bile duct brushings for cholangiocarcinoma in primary sclerosing cholangitis: a systematic review and meta-analysis. Gastrointest Endosc 2014; 79: 783-789
- 9 Barr Fritcher EG, Voss JS, Brankley SM. et al. An optimized set of fluorescence in situ hybridization probes for detection of pancreatobiliary tract cancer in cytology brush samples. Gastroenterology 2015; 149: 1813-1824.e1
- 10 Navaneethan U, Njei B, Lourdusamy V. et al. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 2015; 81: 168-176
- 11 Draganov PV, Chauhan S, Wagh MS. et al. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc 2012; 75: 347-353
- 12 Njei B, McCarty TR, Varadarajulu S. et al. Systematic review with meta-analysis: endoscopic retrograde cholangiopancreatography-based modalities for the diagnosis of cholangiocarcinoma in primary sclerosing cholangitis. Aliment Pharmacol Therap 2016; 44: 1139-1151
- 13 Kaura K, Sawas T, Bazerbachi F. et al. Cholangioscopy biopsies improve detection of cholangiocarcinoma when combined with cytology and FISH, but not in patients with PSC. Dig Dis Sci 2020; 65: 1471-1478
- 14 Rizvi S, Eaton JE, Gores GJ. Primary sclerosing cholangitis as a premalignant biliary tract disease: surveillance and management. Clin Gastroenterol Hepatol 2015; 13: 2152-2165
- 15 Bowlus CL, Lim JK, Lindor KD. AGA Clinical Practice Update on Surveillance for Hepatobiliary Cancers in Patients With Primary Sclerosing Cholangitis: Expert Review. Clin Gastroenterol Hepatol 2019; 17: 2416-2422
- 16 Navaneethan U, Hasan MK, Lourdusamy V. et al. Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: a systematic review. Gastrointest Endosc 2015; 82: 608-14.e2
- 17 SpyBiteMax. https://www.bostonscientific.com/en-US/products/forceps/spybite-max-biopsy-forceps.html
- 18 Hookey LC, Hurlbut DJ, Day AG. et al. One bite or two? A prospective trial comparing colonoscopy biopsy technique in patients with chronic ulcerative colitis. Can J Gastroenterol 2007; 21: 164-168
- 19 Padda S, Shah I, Ramirez FC. Adequacy of mucosal sampling with the "two-bite" forceps technique: a prospective, randomized, blinded study. Gastrointest Endosc 2003; 57: 170-173
- 20 Sharaf RN, Shergill AK, Odze RD. et al. Endoscopic mucosal tissue sampling. Gastrointest Endosc 2013; 78: 216-224
- 21 Kamp EJCA, Dinjens WNM, Doukas M. et al. Optimal tissue sampling during ERCP and emerging molecular techniques for the differentiation of benign and malignant biliary strictures. Therap Adv Gastroenterol 2021; 14 DOI: 10.1177/17562848211002023.
- 22 Korc P, Sherman S. ERCP tissue sampling. Gastrointest Endosc 2016; 84: 557-571
- 23 Blechacz B, Komuta M, Roskams T. et al. Clinical diagnosis and staging of cholangiocarcinoma. Nat Rev Gastroenterol Hepatol 2011; 8: 512-522
- 24 Badshah MB, Vanar V, Kandula M. et al. Peroral cholangioscopy with cholangioscopy-directed biopsies in the diagnosis of biliary malignancies: a systemic review and meta-analysis. Eur J Gastroenterol Hepatol 2019; 31: 935-940
- 25 Singhi AD, Nikiforova MN, Chennat J. et al. Integrating next-generation sequencing to endoscopic retrograde cholangiopancreatography (ERCP)-obtained biliary specimens improves the detection and management of patients with malignant bile duct strictures. Gut 2020; 69: 52
- 26 Arechederra M, Rullan M, Amat I. et al. Next-generation sequencing of bile cell-free DNA for the early detection of patients with malignant biliary strictures. Gut 2022; 71: 1141-1151
- 27 Dudley JC, Zheng Z, McDonald T. et al. Next-generation sequencing and fluorescence in situ hybridization have comparable performance characteristics in the analysis of pancreaticobiliary brushings for malignancy. J Mol Diagn 2016; 18: 124-130
- 28 Hunt JL. Molecular pathology in anatomic pathology practice: a review of basic principles. Arch Pathol Lab Med 2008; 132: 48-60
- 29 Portier BP, Wang Z, Downs-Kelly E. et al. Delay to formalin fixation 'cold ischemia time': effect on ERBB2 detection by in-situ hybridization and immunohistochemistry. Mod Pathol 2013; 26: 1-9
- 30 Mahmoudi N, Enns R, Amar J. et al. Biliary brush cytology: factors associated with positive yields on biliary brush cytology. World J Gastroenterol 2008; 14: 569-573
- 31 de Bellis M, Fogel EL, Sherman S. et al. Influence of stricture dilation and repeat brushing on the cancer detection rate of brush cytology in the evaluation of malignant biliary obstruction. Gastrointest Endosc 2003; 58: 176-182
- 32 Naitoh I, Nakazawa T, Kato A. et al. Predictive factors for positive diagnosis of malignant biliary strictures by transpapillary brush cytology and forceps biopsy. J Dig Dis 2016; 17: 44-51