High sensitivity of ROSE-supported ERCP-guided brushing for biliary strictures
Open Access
- 18 February 2021
- journal article
- research article
- Published by Georg Thieme Verlag KG in Endoscopy International Open
- Vol. 09 (03), E363-E370
- https://doi.org/10.1055/a-1322-2638
Abstract
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in biliary strictures, with brushing being a cheap and fast method to acquire a cytological specimen, despite a sensitivity around 45 %. Rapid on-site evaluation (ROSE) is widely used for endoscopic ultrasound-acquired cytological specimen adequacy, improving its sensitivity and specificity. Nevertheless, no study has evaluated its role for ERCP-guided brushing. Our aim was to assess the diagnostic yield of ERCP-guided brushing of biliary strictures when supported by ROSE. Patients and methods This was a retrospective single-center study that included patients undergoing ERCP-guided brush cytology supported by ROSE for biliary strictures. Recorded data included patient clinical-radiological and ERCP features. Final diagnosis was determined after surgery, intraductal biopsy or adequate follow-up. The diagnostic yield was calculated and a subgroup analysis for factors associated with false-negative or true-positive results was performed. Results Two hundred six patients were included, 57.3 % males, median age 72 years, 77.2 % having extrahepatic biliary strictures. Of the patients, 99 % had an adequate sample at ROSE after a mean of 2.6 passages. The diagnostic yield was accuracy 83 %, sensitivity 74.6 %, and specificity 98 %, positive and negative predictive values 98 % and 71 % respectively, with an area under the curve of 0.86. A diagnosis of cholangiocarcinoma was significantly more frequent among true-positive cases (68 % vs 46.8 %; P = 0.04). Conclusions This is the first study evaluating the use of ROSE as support for ERCP-guided brushing of biliary strictures, with a sensitivity far higher than those reported for brushing alone and at least comparable to those of more expensive and invasive techniques. Received: 12 August 2020 Accepted: 21 October 2020 Publication Date: 19 February 2021 (online) © 2021. 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 commecial 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, GermanyThis publication has 24 references indexed in Scilit:
- Mapping international practice patterns in EUS-guided tissue sampling: outcome of a global surveyEndoscopy International Open, 2016
- Monocentric study of bile aspiration associated with biliary brushing performed during endoscopic retrograde cholangiopancreatography in 239 patients with symptomatic biliary strictureCancer Cytopathology, 2015
- Evaluation of indeterminate biliary stricturesNature Reviews Gastroenterology & Hepatology, 2015
- Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysisGastrointestinal Endoscopy, 2014
- Rapid on-site evaluation of endoscopic-ultrasound-guided fine-needle aspiration diagnosis of pancreatic massesWorld Journal of Gastroenterology, 2014
- Sensitivity of endoscopic retrograde cholangiopancreatography standard cytology: 10-y review of the literatureJournal of Surgical Research, 2013
- Does cytotechnician training influence the accuracy of EUS-guided fine-needle aspiration of pancreatic masses?Digestive and Liver Disease, 2012
- Bile intraductal aspiration (BIDA): a fast method for bile collectionEndoscopy, 2012
- Optical coherence tomography in detection of dysplasia and cancer of the gastrointestinal tract and bilio-pancreatic ductal systemWorld Journal of Gastroenterology, 2008
- Effect of hospital volume on outcome of pancreaticoduodenectomy in ItalyBritish Journal of Surgery, 2007