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 2 mm, 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.
Keywords
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Article info
Publication history
Published online: April 08, 2016
Accepted:
March 13,
2016
Received:
December 23,
2015
Identification
Copyright
© 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
