Cholangioscopy Biopsies Improve Detection of Cholangiocarcinoma When Combined with Cytology and FISH, but Not in Patients with PSC

Karan Kaura, Tarek Sawas, Fateh Bazerbachi, Andrew C. Storm, John A. Martin, Gregory J. Gores, Barham K. Abu Dayyeh, Mark D. Topazian, Michael J. Levy, Bret T. Petersen, Vinay Chandrasekhara

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and Aims: Single-operator cholangioscopy (SOC) has been suggested to be a cost-effective strategy for the detection of cholangiocarcinoma (CCA). The aim of this study is to compare the performance characteristics of SOC-guided biopsies and transpapillary biopsies with standard sampling techniques for the detection of CCA. Methods: A retrospective cohort study of patients undergoing SOC between 1/2007 and 10/2018 at a single academic center was performed. Demographic, procedural, and outcomes data were recorded and analyzed using STATA 14.0. Sensitivity comparison between diagnostic tests was performed using exact McNemar test exclusively among patients with CCA. Two-sided p value < 0.05 was considered statistically significant. Results: Ninety-two patients were included; 36 (39.1%) with primary sclerosing cholangitis (PSC), 41 (44.6%) with CCA, and median follow-up was 15.1 months. In the overall cohort, brush cytology demonstrated a sensitivity of 44.7% and increased with the addition of FISH (56.8%; p = 0.12), FISH with SOC-guided biopsy (71.4%; p = 0.03), and FISH with transpapillary biopsy (64.5%; p = 0.01). However, in patients with PSC, there was no significant improvement in sensitivity with the addition of SOC-guided biopsy or transpapillary biopsy in addition to FISH when compared to brush cytology. There was no difference in the rates of overall adverse events (14% vs. 23.2%; p = 0.27) or infection (3% vs. 4%; p = 0.83) in patients with and without PSC. Conclusions: SOC-guided and transpapillary biopsies improve sensitivity for the detection of cholangiocarcinoma in combination with other ERCP-based techniques compared to brush cytology alone. However, while safe, these modalities do not significantly improve the sensitivity for the detection of malignancy in PSC patients.

Original languageEnglish (US)
JournalDigestive Diseases and Sciences
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Sclerosing Cholangitis
Cholangiocarcinoma
Cell Biology
Biopsy
Endoscopic Retrograde Cholangiopancreatography
Routine Diagnostic Tests
Cohort Studies
Retrospective Studies
Demography
Costs and Cost Analysis
Infection

Keywords

  • Biliary stricture
  • Cholangiocarcinoma
  • Cholangioscopy
  • FISH
  • PSC

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Cholangioscopy Biopsies Improve Detection of Cholangiocarcinoma When Combined with Cytology and FISH, but Not in Patients with PSC. / Kaura, Karan; Sawas, Tarek; Bazerbachi, Fateh; Storm, Andrew C.; Martin, John A.; Gores, Gregory J.; Abu Dayyeh, Barham K.; Topazian, Mark D.; Levy, Michael J.; Petersen, Bret T.; Chandrasekhara, Vinay.

In: Digestive Diseases and Sciences, 01.01.2019.

Research output: Contribution to journalArticle

Kaura, Karan ; Sawas, Tarek ; Bazerbachi, Fateh ; Storm, Andrew C. ; Martin, John A. ; Gores, Gregory J. ; Abu Dayyeh, Barham K. ; Topazian, Mark D. ; Levy, Michael J. ; Petersen, Bret T. ; Chandrasekhara, Vinay. / Cholangioscopy Biopsies Improve Detection of Cholangiocarcinoma When Combined with Cytology and FISH, but Not in Patients with PSC. In: Digestive Diseases and Sciences. 2019.
@article{22906d752d944922a4376121f101f896,
title = "Cholangioscopy Biopsies Improve Detection of Cholangiocarcinoma When Combined with Cytology and FISH, but Not in Patients with PSC",
abstract = "Background and Aims: Single-operator cholangioscopy (SOC) has been suggested to be a cost-effective strategy for the detection of cholangiocarcinoma (CCA). The aim of this study is to compare the performance characteristics of SOC-guided biopsies and transpapillary biopsies with standard sampling techniques for the detection of CCA. Methods: A retrospective cohort study of patients undergoing SOC between 1/2007 and 10/2018 at a single academic center was performed. Demographic, procedural, and outcomes data were recorded and analyzed using STATA 14.0. Sensitivity comparison between diagnostic tests was performed using exact McNemar test exclusively among patients with CCA. Two-sided p value < 0.05 was considered statistically significant. Results: Ninety-two patients were included; 36 (39.1{\%}) with primary sclerosing cholangitis (PSC), 41 (44.6{\%}) with CCA, and median follow-up was 15.1 months. In the overall cohort, brush cytology demonstrated a sensitivity of 44.7{\%} and increased with the addition of FISH (56.8{\%}; p = 0.12), FISH with SOC-guided biopsy (71.4{\%}; p = 0.03), and FISH with transpapillary biopsy (64.5{\%}; p = 0.01). However, in patients with PSC, there was no significant improvement in sensitivity with the addition of SOC-guided biopsy or transpapillary biopsy in addition to FISH when compared to brush cytology. There was no difference in the rates of overall adverse events (14{\%} vs. 23.2{\%}; p = 0.27) or infection (3{\%} vs. 4{\%}; p = 0.83) in patients with and without PSC. Conclusions: SOC-guided and transpapillary biopsies improve sensitivity for the detection of cholangiocarcinoma in combination with other ERCP-based techniques compared to brush cytology alone. However, while safe, these modalities do not significantly improve the sensitivity for the detection of malignancy in PSC patients.",
keywords = "Biliary stricture, Cholangiocarcinoma, Cholangioscopy, FISH, PSC",
author = "Karan Kaura and Tarek Sawas and Fateh Bazerbachi and Storm, {Andrew C.} and Martin, {John A.} and Gores, {Gregory J.} and {Abu Dayyeh}, {Barham K.} and Topazian, {Mark D.} and Levy, {Michael J.} and Petersen, {Bret T.} and Vinay Chandrasekhara",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s10620-019-05866-2",
language = "English (US)",
journal = "Digestive Diseases and Sciences",
issn = "0163-2116",
publisher = "Springer New York",

}

TY - JOUR

T1 - Cholangioscopy Biopsies Improve Detection of Cholangiocarcinoma When Combined with Cytology and FISH, but Not in Patients with PSC

AU - Kaura, Karan

AU - Sawas, Tarek

AU - Bazerbachi, Fateh

AU - Storm, Andrew C.

AU - Martin, John A.

AU - Gores, Gregory J.

AU - Abu Dayyeh, Barham K.

AU - Topazian, Mark D.

AU - Levy, Michael J.

AU - Petersen, Bret T.

AU - Chandrasekhara, Vinay

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background and Aims: Single-operator cholangioscopy (SOC) has been suggested to be a cost-effective strategy for the detection of cholangiocarcinoma (CCA). The aim of this study is to compare the performance characteristics of SOC-guided biopsies and transpapillary biopsies with standard sampling techniques for the detection of CCA. Methods: A retrospective cohort study of patients undergoing SOC between 1/2007 and 10/2018 at a single academic center was performed. Demographic, procedural, and outcomes data were recorded and analyzed using STATA 14.0. Sensitivity comparison between diagnostic tests was performed using exact McNemar test exclusively among patients with CCA. Two-sided p value < 0.05 was considered statistically significant. Results: Ninety-two patients were included; 36 (39.1%) with primary sclerosing cholangitis (PSC), 41 (44.6%) with CCA, and median follow-up was 15.1 months. In the overall cohort, brush cytology demonstrated a sensitivity of 44.7% and increased with the addition of FISH (56.8%; p = 0.12), FISH with SOC-guided biopsy (71.4%; p = 0.03), and FISH with transpapillary biopsy (64.5%; p = 0.01). However, in patients with PSC, there was no significant improvement in sensitivity with the addition of SOC-guided biopsy or transpapillary biopsy in addition to FISH when compared to brush cytology. There was no difference in the rates of overall adverse events (14% vs. 23.2%; p = 0.27) or infection (3% vs. 4%; p = 0.83) in patients with and without PSC. Conclusions: SOC-guided and transpapillary biopsies improve sensitivity for the detection of cholangiocarcinoma in combination with other ERCP-based techniques compared to brush cytology alone. However, while safe, these modalities do not significantly improve the sensitivity for the detection of malignancy in PSC patients.

AB - Background and Aims: Single-operator cholangioscopy (SOC) has been suggested to be a cost-effective strategy for the detection of cholangiocarcinoma (CCA). The aim of this study is to compare the performance characteristics of SOC-guided biopsies and transpapillary biopsies with standard sampling techniques for the detection of CCA. Methods: A retrospective cohort study of patients undergoing SOC between 1/2007 and 10/2018 at a single academic center was performed. Demographic, procedural, and outcomes data were recorded and analyzed using STATA 14.0. Sensitivity comparison between diagnostic tests was performed using exact McNemar test exclusively among patients with CCA. Two-sided p value < 0.05 was considered statistically significant. Results: Ninety-two patients were included; 36 (39.1%) with primary sclerosing cholangitis (PSC), 41 (44.6%) with CCA, and median follow-up was 15.1 months. In the overall cohort, brush cytology demonstrated a sensitivity of 44.7% and increased with the addition of FISH (56.8%; p = 0.12), FISH with SOC-guided biopsy (71.4%; p = 0.03), and FISH with transpapillary biopsy (64.5%; p = 0.01). However, in patients with PSC, there was no significant improvement in sensitivity with the addition of SOC-guided biopsy or transpapillary biopsy in addition to FISH when compared to brush cytology. There was no difference in the rates of overall adverse events (14% vs. 23.2%; p = 0.27) or infection (3% vs. 4%; p = 0.83) in patients with and without PSC. Conclusions: SOC-guided and transpapillary biopsies improve sensitivity for the detection of cholangiocarcinoma in combination with other ERCP-based techniques compared to brush cytology alone. However, while safe, these modalities do not significantly improve the sensitivity for the detection of malignancy in PSC patients.

KW - Biliary stricture

KW - Cholangiocarcinoma

KW - Cholangioscopy

KW - FISH

KW - PSC

UR - http://www.scopus.com/inward/record.url?scp=85073975937&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073975937&partnerID=8YFLogxK

U2 - 10.1007/s10620-019-05866-2

DO - 10.1007/s10620-019-05866-2

M3 - Article

C2 - 31571103

AN - SCOPUS:85073975937

JO - Digestive Diseases and Sciences

JF - Digestive Diseases and Sciences

SN - 0163-2116

ER -