Advertisement

Digestive Diseases and Sciences

, Volume 64, Issue 1, pp 241–248 | Cite as

Diagnostic Ability of Endoscopic Bile Cytology Using a Newly Designed Biliary Scraper for Biliary Strictures

  • Kazunari NakaharaEmail author
  • Yosuke Michikawa
  • Ryo Morita
  • Keigo Suetani
  • Nozomi Morita
  • Junya Sato
  • Kensuke Tsuji
  • Hiroki Ikeda
  • Kotaro Matsunaga
  • Tsunamasa Watanabe
  • Nobuyuki Matsumoto
  • Shinjiro Kobayashi
  • Takehito Otsubo
  • Fumio Itoh
Original Article

Abstract

Background

A new device with metallic wires for scrape cytology was developed.

Aims

To compare the diagnostic performance of scrape cytology and conventional cytology during endoscopic retrograde cholangiopancreatography for biliary strictures.

Methods

A total of 420 cases with biliary stricture underwent transpapillary bile cytology. Among them, there are 79 cases with scrape cytology using the new device (scrape group) and 341 cases with conventional cytology (control group). Seventy-two and 174 cases underwent biliary biopsy at the same time as bile cytology in the scrape and control group, respectively.

Results

The sensitivity for malignancy of bile cytology in the scrape and control group was 41.2% [pancreatic cancer (PC): 23.1%, biliary cancer (BC): 52.5%] and 27.1% (PC: 16.3%, BC: 38.0%), respectively (P = 0.023). When analyzed PC and BC, respectively, there was no significant difference between the two groups. In the both groups, the sensitivity was significantly higher for BC than PC. In the scrape group, there was no difference in the sensitivity between cytology and biopsy [39.7% (PC: 17.4%, BC: 55.3%)], but in the control group, a significantly lower sensitivity was observed with cytology than biopsy (36.4% (PC: 19.7%, BC: 50.0%)) (P = 0.046). When analyzed PC and BC, respectively, there was no significant difference between cytology and biopsy. The sensitivity of combined cytology and biopsy was 55.6% (PC: 30.4%, BC: 71.1%) in the scrape group and 47.0% (PC: 24.6%, BC: 64.3%) in the control group.

Conclusion

Scrape bile cytology for biliary strictures may be superior to conventional cytology.

Keywords

Endoscopic retrograde cholangiopancreatography Bile cytology Brush cytology Biliary biopsy Biliary stricture 

Notes

Funding

The authors report that no financial support for this study was provided.

Compliance with ethical standards

Conflict of interest

Authors declare no conflict of interests for this article.

References

  1. 1.
    Foutch PG, Kerr DM, Harlan JR, Kummet TD. A prospective, controlled analysis of endoscopic cytotechniques for diagnosis of malignant biliary strictures. Am J Gastroenterol. 1991;86:577–580.PubMedGoogle Scholar
  2. 2.
    Desa LA, Akosa AB, Lazzara S, Domizio P, Krausz T, Benjamin IS. Cytodiagnosis in the management of extrahepatic biliary stricture. Gut. 1991;32:1188–1191.CrossRefGoogle Scholar
  3. 3.
    Mansfield JC, Griffin SM, Wadehra V, Matthewson K. A prospective evaluation of cytology from biliary strictures. Gut. 1997;40:671–677.CrossRefGoogle Scholar
  4. 4.
    Sugiyama M, Atomi Y, Wada N, Kuroda A, Muto T. Endoscopic transpapillary bile duct biopsy without sphincterotomy for diagnosing biliary strictures: a prospective comparative study with bile and brush cytology. Am J Gastroenterol. 1996;91:465–467.PubMedGoogle Scholar
  5. 5.
    Davidson B, Varsamidakis N, Dooley J, et al. Value of exfoliative cytology for investigating bile duct strictures. Gut. 1992;33:1408–1411.CrossRefGoogle Scholar
  6. 6.
    Kurzawinski TR, Deery A, Dooley JS, Dick R, Hobbs KE, Davidson BR. A prospective study of biliary cytology in 100 patients with bile duct strictures. Hepatology. 1993;18:1399–1403.CrossRefGoogle Scholar
  7. 7.
    Hattori M, Nagino M, Ebata T, Kato K, Okada K, Shimoyama Y. Prospective study of biliary cytology in suspected perihilar cholangiocarcinoma. Br J Surg. 2011;98:704–709.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    Jailwala J, Fogel EL, Sherman S, et al. Triple-tissue sampling at ERCP in malignant biliary obstruction. Gastrointest Endosc. 2000;51:383–390.CrossRefGoogle Scholar
  10. 10.
    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.CrossRefGoogle Scholar
  11. 11.
    Weber A, von Weyhern C, Fend F, et al. Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma. World J Gastroenterol. 2008;14:1097–1101.CrossRefGoogle Scholar
  12. 12.
    Pugliese V, Conio M, Nicolò G, Saccomanno S, Gatteschi B. Endoscopic retrograde forceps biopsy and brush cytology of biliary strictures: a prospective study. Gastrointest Endosc. 1995;42:520–526.CrossRefGoogle Scholar
  13. 13.
    Kitajima Y, Ohara H, Nakazawa T, et al. Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures. J Gastroenterol Hepatol. 2007;22:1615–1620.CrossRefGoogle Scholar
  14. 14.
    De Bellis M, Sherman S, Fogel EL, et al. Tissue sampling at ERCP in suspected malignant biliary strictures (Part 2). Gastrointest Endosc. 2002;56:720–730.CrossRefGoogle Scholar
  15. 15.
    Ferrari Júnior AP, Lichtenstein DR, Slivka A, Chang C, Carr-Locke DL. Brush cytology during ERCP for the diagnosis of biliary and pancreatic malignancies. Gastrointest Endosc. 1994;40:140–145.CrossRefGoogle Scholar
  16. 16.
    Glasbrenner B, Ardan M, Boeck W, Preclik G, Möller P, Adler G. Prospective evaluation of brush cytology of biliary strictures during endoscopic retrograde cholangiopancreatography. Endoscopy. 1999;31:712–717.CrossRefGoogle Scholar
  17. 17.
    Harewood GC, Baron TH, Stadheim LM, Kipp BR, Sebo TJ, Salomao DR. Prospective, blinded assessment of factors influencing the accuracy of biliary cytology interpretation. Am J Gastroenterol. 2004;99:1464–1469.CrossRefGoogle Scholar
  18. 18.
    Sasaki Y, Okabe Y, Ishida Y, et al. Evaluation of endoscopic transpapillary brushing cytology for the diagnosis of bile duct cancer based on the histopathologic findings. Dig Dis Sci. 2014;59:2314–2319.CrossRefGoogle Scholar
  19. 19.
    Lee JG, Leung JW, Baillie J, Layfield LJ, Cotton PB. Benign, dysplastic, or malignant–making sense of endoscopic bile duct brush cytology: results in 149 consecutive patients. Am J Gastroenterol. 1995;90:722–726.PubMedGoogle Scholar
  20. 20.
    Kubota Y, Takaoka M, Tani K, et al. Endoscopic transpapillary biopsy for diagnosis of patients with pancreaticobiliary ductal strictures. Am J Gastroenterol. 1993;88:1700–1704.PubMedGoogle Scholar
  21. 21.
    Schoefl R, Haefner M, Wrba F, et al. Forceps biopsy and brush cytology during endoscopic retrograde cholangiopancreatography for the diagnosis of biliary stenoses. Scand J Gastroenterol. 1997;32:363–368.CrossRefGoogle Scholar
  22. 22.
    Kawashima H, Itoh A, Ohno E, Goto H, Hirooka Y. Transpapillary biliary forceps biopsy to distinguish benign biliary stricture from malignancy: how many tissue samples should be obtained? Dig Endosc. 2012;24:22–27.CrossRefGoogle Scholar
  23. 23.
    Sakuma Y, Kodama Y, Sogabe Y, et al. Diagnostic performance of a new endoscopic scraper for malignant biliary strictures: a multicenter prospective study. Gastrointest Endosc. 2017;85:371–379.CrossRefGoogle Scholar
  24. 24.
    Hewitt MJ, McPhail MJ, Possamai L, Dhar A, Vlavianos P, Monahan KJ. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc. 2012;75:319–331.CrossRefGoogle Scholar
  25. 25.
    Chen J, Yang R, Lu Y, Xia Y, Zhou H. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesion: a systematic review. J Cancer Res Clin Oncol. 2012;138:1433–1441.CrossRefGoogle Scholar
  26. 26.
    Puli SR, Bechtold ML, Buxbaum JL, Eloubeidi MA. How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass?: a meta-analysis and systematic review. Pancreas. 2013;42:20–26.CrossRefGoogle Scholar
  27. 27.
    Chen G, Liu S, Zhao Y, Dai M, Zhang T. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: a meta-analysis. Pancreatology. 2013;13:298–304.CrossRefGoogle Scholar
  28. 28.
    Banafea O, Mghanga FP, Zhao J, Zhao R, Zhu L. Endoscopic ultrasonography with fine-needle aspiration for histological diagnosis of solid pancreatic masses: a meta-analysis of diagnostic accuracy studies. BMC Gastroenterol. 2016;31:108.  https://doi.org/10.1186/s12876-016-0519-z.CrossRefGoogle Scholar
  29. 29.
    Uchida N, Kamada H, Ono M, et al. How many cytological examinations should be performed for the diagnosis of malignant biliary stricture via an endoscopic nasobiliary drainage tube? J Gastroenterol Hepatol. 2008;23:1501–1504.CrossRefGoogle Scholar
  30. 30.
    Yagioka H, Hirano K, Isayama H, et al. Clinical significance of bile cytology via an endoscopic nasobiliary drainage tube for pathological diagnosis of malignant biliary strictures. J Hepatobiliary Pancreat Sci. 2011;18:211–215.CrossRefGoogle Scholar
  31. 31.
    Kipp BR, Stadheim LM, Halling SA, et al. A comparison of routine cytology and fluorescence in situ hybridization for the detection of malignant bile duct strictures. Am J Gastroenterol. 2004;99:1675–1681.CrossRefGoogle Scholar
  32. 32.
    Chaiteerakij R, Barr Fritcher EG, Angsuwatcharakon P, et al. Fluorescence in situ hybridization compared with conventional cytology for the diagnosis of malignant biliary tract strictures in Asian patients. Gastrointest Endosc. 2016;83:1228–1235.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Kazunari Nakahara
    • 1
    Email author
  • Yosuke Michikawa
    • 1
  • Ryo Morita
    • 1
  • Keigo Suetani
    • 1
  • Nozomi Morita
    • 1
  • Junya Sato
    • 1
  • Kensuke Tsuji
    • 1
  • Hiroki Ikeda
    • 1
  • Kotaro Matsunaga
    • 1
  • Tsunamasa Watanabe
    • 1
  • Nobuyuki Matsumoto
    • 1
  • Shinjiro Kobayashi
    • 2
  • Takehito Otsubo
    • 2
  • Fumio Itoh
    • 1
  1. 1.Department of Gastroenterology and HepatologySt. Marianna University School of MedicineKawasakiJapan
  2. 2.Department of Gastroenterogical and General SurgerySt. Marianna University School of MedicineKawasakiJapan

Personalised recommendations