Hilar Cholangiocarcinoma: A Comparison of Endoscopic Transpapillary Brush Cytology an Forceps Biopsy
C Hann von Weyhern, A Weber, J Schneider, B Neu, A Meining, H Weidenbach, RM Schmid, F Fend, C Prinz. University Hospital Tuebingen, Tuebingen, Germany; University Hospital Technical University, Munich, Germany
Background: Analysis of current epidemiological data shows an increasing incidence of extrahepatic cholangiocarcinoma . The prognosis of this neoplasm is poor, mainly due to the late appearance of symptoms and difficulties in separating benign and malignant strictures of bile ducts both by imaging, as well as, in endoscopic biopsy material. An increase in the diagnostic sensitivity and specificity is therefore urgently needed.
Design: All cases with histologically or cytologically proven extrahepatic cholangiocarcinoma with available clinical follow-up from the period 1995 to 2005, in whom both transpapillary brush cytology and forceps biopsy had been performed for diagnostic purposes, were included in the study. Patients with intrahepatic cholangiocarcinoma, and patients without surgery, in whom no evidence of disease progression during a period of 18 months made a malignant diagnosis unlikely, were excluded. The clinical and follow-up data, as well as, all available diagnostic material was reviewed.
Results: Fifty-eight patients with a median age of 68 years with malignant bile duct tumours staged according to Bismuth were included in the study. In 18.9% of patients, more than one endoscopy with diagnostic biopsy had been performed. The mean number of tissue sampling sessions was 1.3 per patient. Brush cytology alone had a sensitivity of 41.4% (24/58), compared to 53.4% (31/58) for forceps biopsy. Combination of cytology and biopsy resulted in a minor increase of sensitivity to 60.3% (35/58). 34.4% (20/58) patients had both positive cytology and histology, 19% (11/58) had positive histology only, and 6.9% (4/58) were positive only in cytology.
Conclusions: The combination of forceps biopsy and brush cytology for the endoscopic diagnosis of proximal cholangiocarcinomas according to Bismuth classification leads to a moderate increase in diagnostic sensitivity, but still fails to establish the diagnosis in almost 40% of cases. Since timely diagnosis is of importance for potentially curative surgery, introduction of supplementary techniques such as fluorescence in situ hybridization should be evaluated for cases of morphologically negative specimens of bile duct strictures.
Monday, March 9, 2009 1:00 PM
Poster Session II # 89, Monday Afternoon