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Cheng TL, Huang ZS, Zhang J, Wang J, Zhao J, Kontogianni K, Fu WL, Wu N, Kuebler WM, Herth FJ, Fan Y. Comparison of cryobiopsy and forceps biopsy for the diagnosis of mediastinal lesions: A randomised clinical trial. Pulmonology 2024:S2531-0437(23)00240-4. [PMID: 38182469 DOI: 10.1016/j.pulmoe.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard approach for lung cancer staging. However, its diagnostic utility for other mediastinal diseases might be hampered by the limited tissue retrieved. Recent evidence suggests the novel sampling strategies of forceps biopsy and cryobiopsy as auxiliary techniques to EBUS-TBNA, considering their capacity for larger diagnostic samples. METHODS This study determined the added value of forceps biopsy and cryobiopsy for the diagnosis of mediastinal diseases. Consecutive patients with mediastinal lesions of 1 cm or more in the short axis were enrolled. Following completion of needle aspiration, three forceps biopsies and one cryobiopsy were performed in a randomised pattern. Primary endpoints included diagnostic yield defined as the percentage of patients for whom mediastinal biopsy led to a definite diagnosis, and procedure-related complications. RESULTS In total, 155 patients were recruited and randomly assigned. Supplementing EBUS-TBNA with either forceps biopsy or cryobiopsy increased diagnostic yield, with no significant difference between EBUS-TBNA plus forceps biopsy and EBUS-TBNA plus cryobiopsy (85.7 % versus 91.6 %, P = 0.106). Yet, samples obtained by additional cryobiopsies were more qualified for lung cancer molecular testing than those from forceps biopsies (100.0 % versus 89.5 %, P = 0.036). When compared directly, the overall diagnostic yield of cryobiopsy was superior to forceps biopsy (85.7 % versus 70.8 %, P = 0.001). Cryobiopsies produced greater samples in shorter procedural time than forceps biopsies. Two (1.3 %) cases of postprocedural pneumothorax were detected. CONCLUSIONS Transbronchial mediastinal cryobiopsy might be a promising complementary tool to supplement traditional needle biopsy for increased diagnostic yield and tissue harvesting. TRIAL REGISTRATION ChiCTR2000030373.
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Affiliation(s)
- T-L Cheng
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Z-S Huang
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - J Zhang
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - J Wang
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - J Zhao
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - K Kontogianni
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, and Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - W-L Fu
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - N Wu
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - W M Kuebler
- Department of Pathology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - F J Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, and Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Y Fan
- Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
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Meng WD, Lum M, Yu E, Krishna G. Performance of Biopsy Tools in Procurement of Lung Tissue in Robot-Assisted Peripheral Navigation: A Comparison. Respiration 2023; 102:1007-1015. [PMID: 38035570 DOI: 10.1159/000535234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Robot-assisted navigation bronchoscopy (RANB) has been gaining traction as a new technology for minimally invasive biopsies of peripheral pulmonary lesions (PPLs). Cryobiopsy is an established method of procuring satisfactory lung tissues and can be safely paired with RANB. While some studies have evaluated the diagnostic accuracy and yield of this procedure, there is limited data on the utility of various biopsy tools, the sequence of use and differences in tissue characteristics based on the sampling techniques. Therefore, this study aims to examine the real-life performance of needle, forceps and cryoprobe when utilized in succession with RANB in the biopsy of PPLs, and to evaluate the specific types of tissue samples obtained from each instrument. METHODS In a single-center retrospective study, 50 patients presenting 52 PPLs underwent biopsies sequentially using fine-needle aspiration (FNA), forceps, and cryoprobe. All procedures were performed via cone-beam CT-assisted RANB. Performance metrics, such as diagnostic yield, sensitivity, and specificity, were determined by classifying malignancy as true positives and explicit benign findings as true negatives. Tissue sizes and subtypes were based on pathology description and compared with Student's t test and χ2, respectively. RESULTS Cryobiopsy, when performed sequentially after FNA then forceps, was able to retrieve more alveolar tissue (p = 0.0098) among diagnosed lesions and showed higher diagnostic yield (p = 0.001) in PPL biopsy with RANB platform. Cryobiopsy was also able to obtain larger sample size (p = 0.0087). No difference was observed in the diagnosis of malignancy between forceps and cryobiopsy (p = 0.8877). CONCLUSION The integration of RANB and sequential biopsies, utilizing FNA, forceps, and cryoprobe, can efficiently diagnose PPLs and procure alveolar tissues. Further research based on histopathological subtypes is required to assess its prognostic significance.
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Affiliation(s)
- William D Meng
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, California, USA
| | - Mendy Lum
- Division of Respiratory Medicine, Department of Medicine, El Camino Hospital, Mountain View, California, USA
| | - Elizabeth Yu
- Division of Pulmonary and Critical Care, Department of Medicine, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Ganesh Krishna
- Division of Pulmonary and Critical Care, Department of Medicine, Palo Alto Medical Foundation, Palo Alto, California, USA
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Hong HJ, Jeong SH, Kim WS, Kim YJ. Safety of esophagogastroduodenoscopy-guided forceps biopsy and the feasibility of esophagogastroduodenoscopy for evaluation of hypopharyngeal cancer. BMC Surg 2019; 19:105. [PMID: 31395049 PMCID: PMC6686408 DOI: 10.1186/s12893-019-0571-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/30/2019] [Indexed: 12/11/2022] Open
Abstract
Background There is currently no established standard tissue sampling method for hypopharyngeal cancer. The present study aimed to evaluate the feasibility of esophagogastroduodenoscopy (EGD) for the pretreatment evaluation of hypopharyngeal cancer and the safety of EGD-guided forceps biopsy. Methods We reviewed nine patients with hypopharyngeal cancer who underwent EGD for the evaluation of tumor extent and tissue biopsy from March 2014 to March 2017 at International St. Mary’s Hospital. One experienced endoscopist performed all the EGD procedures in the presence of a head and neck surgeon. The procedure included determining tumor location, extent (presence of pyriform sinus apex involvement), and size, and passing the endoscope through the upper esophageal sphincter. The success rate of tissue sampling was assessed, and procedure-related complications were recorded. Results All patients were male, with a mean age of 69.9 ± 10.9 years (range 61–69 years). Tissue sampling using biopsy forceps was performed in 6/9 patients (66.7%). No complications related to moderate sedation or biopsy, including post-biopsy bleeding or respiratory distress, were reported. Histologic confirmation was successful in 5/6 patients (83.3%). Upper gastrointestinal lesions were evaluated in 7/9 (77.8%) patients in whom the scope passed through the lesion. Conclusions EGD and EGD-guided forceps biopsy may be useful for the evaluation of hypopharyngeal cancer extent and tissue sampling, respectively. Electronic supplementary material The online version of this article (10.1186/s12893-019-0571-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hyun Jun Hong
- Department of Otorhinolaryngology, International St. Mary's Hospital, Catholic Kwandong Universtiy College of Medicine, Incheon, South Korea
| | - Seok-Hoo Jeong
- Department of Gastroenterology, International St. Mary's Hospital, Catholic Kwandong Universtiy College of Medicine, Incheon, South Korea
| | - Won Shik Kim
- Division of Gastroenterology, Deparment of Internal Medicine, Kangnam Sacred-Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, South Korea
| | - Yu Jin Kim
- Department of Gastroenterology, International St. Mary's Hospital, Catholic Kwandong Universtiy College of Medicine, Incheon, South Korea. .,Division of Gastroenterology, Department of Internal Medicine, Kangnam Sacred-Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, South Korea. .,Yonsei University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, Republic of Korea.
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Hetzel J, Eberhardt R, Petermann C, Gesierich W, Darwiche K, Hagmeyer L, Muche R, Kreuter M, Lewis R, Ehab A, Boeckeler M, Haentschel M. Bleeding risk of transbronchial cryobiopsy compared to transbronchial forceps biopsy in interstitial lung disease - a prospective, randomized, multicentre cross-over trial. Respir Res 2019; 20:140. [PMID: 31277659 PMCID: PMC6612220 DOI: 10.1186/s12931-019-1091-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/03/2019] [Indexed: 01/01/2023] Open
Abstract
Background Bronchoscopic cryobiopsy is a new method of bronchoscopic tissue sampling in interstitial lung disease. In case of transbronchial biopsies, the resultant tissue samples are of high quality, and the lung parenchyma seen in the samples is adequate for a histological diagnosis in most cases. Bleeding after transbronchial biopsy is the most important procedure- associated complication and may be life threatening. This study addresses the risk of bleeding of transbronchial cryobiopsy. Methods In this prospective, randomized, controlled multicentre study 359 patients with interstitial lung disease requiring diagnostic bronchoscopic tissue sampling were included. Both conventional transbronchial forceps biopsy and transbronchial cryobiopsy were undertaken in each patient. The sequence of the procedures was randomized. Bleeding severity was evaluated semi-quantitatively as “no bleeding”, “mild” (suction alone), “moderate” (additional intervention) or “severe” (prolonged monitoring necessary or fatal outcome), for each intervention. Results In 359 patients atotal of 1160 cryobiopsies and 1302 forceps biopsies were performed. Bleeding was observed after forceps biopsy in 173 patients (48.2%) and after cryobiopsy in 261 patients (72.7%). Bleeding was significantly greater in the cryobiopsy group (cryobiopsy/forceps biopsy: no bleeding 27.3%/51.8%; mild 56.5%/44.0%; moderate 15.0%/4.2%; severe 1.2%/0%; p < 0.001). The rate of clinically relevant bleeding (moderate or severe) was higher after the cryobiopsy procedures compared to the forceps biopsies (16.2% vs. 4.2%, p < 0.05). No fatal bleeding complications occurred. Conclusions Compared to transbronchial forceps biopsy, transbronchial cryobiopsy was associated with an increased risk of bleeding which is of clinical relevance. Therefore training and additional precautions for bleeding control should be considered. Trial registration The study was registered with clinicaltrials.gov (NCT01894113).
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Affiliation(s)
- Juergen Hetzel
- Department of Haematology, Oncology, Rheumatology, Immunology and Pulmology, Eberhard Karls University, Otfried-Mueller-Str. 10, 70771, Tübingen, Germany.
| | - Ralf Eberhardt
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg (TLRCH, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Christoph Petermann
- Department for Pulmonary Diseases, Asklepios-Klinik Harburg, Hamburg, Germany
| | | | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Lars Hagmeyer
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, Ulm University Ulm, Ulm, Germany
| | - Michael Kreuter
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg (TLRCH, German Center for Lung Research (DZL), Heidelberg, Germany
| | | | - Ahmed Ehab
- Department of Haematology, Oncology, Rheumatology, Immunology and Pulmology, Eberhard Karls University, Otfried-Mueller-Str. 10, 70771, Tübingen, Germany
| | - Michael Boeckeler
- Department of Haematology, Oncology, Rheumatology, Immunology and Pulmology, Eberhard Karls University, Otfried-Mueller-Str. 10, 70771, Tübingen, Germany
| | - Maik Haentschel
- Department of Haematology, Oncology, Rheumatology, Immunology and Pulmology, Eberhard Karls University, Otfried-Mueller-Str. 10, 70771, Tübingen, Germany
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Hou G, Miao Y, Hu XJ, Wang W, Wang QY, Wu GP, Wang EH, Kang J. The optimal sequence for bronchial brushing and forceps biopsy in lung cancer diagnosis: a random control study. J Thorac Dis 2016; 8:520-6. [PMID: 27076949 DOI: 10.21037/jtd.2016.02.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Optimizing basic techniques in diagnostic bronchoscopy is important for improving medical services in developing countries. In this study, the optimal sequence of bronchial brushing relative to bronchial biopsy for lung cancer diagnosis was evaluated. METHODS A total of 420 patients with visible endobronchial tumors were prospectively and randomly enrolled in two groups: a pre-biopsy brushing group, receiving two brushings before biopsy; two brushings which performed afterwards; were set as self-control and compared with the pre-biopsy brushings as the intra-group comparison; and a post-biopsy brushing group, only receiving two brushings after biopsy, which were compared with the pre-biopsy brushings as the inter-group comparison. Diagnostic yield of brushing was compared before and after biopsy, and as well as for different tumor pathologies and bronchoscopic morphologies. The occurrence of treated bleeding which defined as bleeding needed further intervention with argon plasma coagulation and/or anti-coagulation drugs in two groups was also compared. RESULTS Only patients with a definitive cytological or histological diagnosis of lung cancer based on bronchoscopy or other confirmatory techniques were included. Patients were excluded if they had submucosal lesions, extrinsic compressions, pulmonary metastasis of extrapulmonary malignancies or uncommon non-small cell lung carcinoma (NSCLC). A total of 362 patients who met the inclusion criteria were analyzed. Diagnostic yield for pre-biopsy brushing (49.2%, 88/179) was significantly higher than for post-biopsy brushing within the same pre-biopsy brushing group (31.8%, 57/179) (P=0.007) as the intra-group comparison, and significantly higher than for post-biopsy brushing in the post group (30.6%, 56/183) (P<0.001) as the inter-group comparison. No difference in occurrence of treated bleeding for pre- vs. post-biopsy bronchial brushing was found. CONCLUSIONS Supplementing bronchoscopic forceps biopsy with brushing improves diagnostic yield in lung cancer. In cases of endobronchial exophytic tumors, pre-biopsy brushing appears to be superior to post-biopsy brushing.
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Affiliation(s)
- Gang Hou
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Yuan Miao
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Xue-Jun Hu
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Wei Wang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Qiu-Yue Wang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Guang-Ping Wu
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - En-Hua Wang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Jian Kang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
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Shinjo K, Matsubayashi H, Matsui T, Kawata N, Uemura S, Yamamoto Y, Ono H. Biliary hemostasis using an endoscopic plastic stent placement for uncontrolled hemobilia caused by transpapillary forceps biopsy (with video). Clin J Gastroenterol. 2016;9:86-88. [PMID: 26960930 DOI: 10.1007/s12328-016-0637-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/02/2016] [Indexed: 12/12/2022]
Abstract
A 78-year-old woman was referred to our hospital for the examination and treatment of jaundice. A transpapillary forceps biopsy for a long distal bile duct stricture was performed using endoscopic retrograde cholangiopancreatography. Immediately after the biopsy, massive bleeding was observed from the orifice of the papilla. Although hemobilia was pulsatile, an endoscopic biliary plastic stent placement was very effective in achieving hemostasis. However, a nasal biliary catheter was required because a blood clot clogged the stent on the following day. Although covered self-expandable metal stent (CSEMS) placement has been reported for achieving endoscopic hemostasis for bleeding, we chose to use a plastic stent to reduce the risk of post-procedure pancreatitis. The placement of both an endoscopic biliary plastic stent and a nasobiliary drainage catheter can be an alternative hemostatic tool to CSEMSs.
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Abstract
Endoscopic forceps biopsy is essential before planning an endoscopic resection of upper gastrointestinal epithelial tumors. However, forceps biopsy is limited by its superficiality and frequency of sampling errors. Histologic discrepancies between endoscopic forceps biopsies and resected specimens are frequent. Factors associated with such histologic discrepancies are tumor size, macroscopic type, surface color, and the type of medical facility. Precise targeting of biopsies is recommended to achieve an accurate diagnosis, curative endoscopic resection, and a satisfactory oncologic outcome. Multiple deep forceps biopsies can induce mucosal ulceration in early gastric cancer. Endoscopic resection for early gastric cancer with ulcerative findings is associated with piecemeal resection, incomplete resection, and a risk for procedure-related complications such as bleeding and perforation. Such active ulcers caused by forceps biopsy and following submucosal fibrosis might also be mistaken as an indication for more aggressive procedures, such as gastrectomy with D2 lymph node dissection. Proton pump inhibitors might be prescribed to facilitate the healing of biopsy-induced ulcers if an active ulcer is predicted after deep biopsy. It is unknown which time interval from biopsy to endoscopic resection is appropriate for a safe procedure and a good oncologic outcome. Further investigations are needed to conclude the appropriate time interval.
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Affiliation(s)
- Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
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Abstract
Cholangiocarcinomas arise from the epithelial cells of the bile ducts and are associated with poor prognosis. Despite new diagnostic approaches, the definite diagnosis of this malignancy continues to be challenging. Cholangiocarcinomas often grow longitudinally along the bile duct rather than in a radial direction. Thus, large tumor masses are frequently absent and imaging techniques, including ultrasound, CT, and MRI have only limited sensitivity. Tissue collection during endoscopic (ERCP) and/or percutaneous transhepatic (PTC) procedures are usually used to confirm a definitive diagnosis of cholangiocarcinoma. However, forceps biopsy and brush cytology provide positive results for malignancy in about only 50% of patients. Percutaneous and peroral cholangioscopy using fiber-optic techniques were therefore developed for direct visualization of the biliary tree, yielding additional information about endoscopic appearance and tumor extension, as well as a guided biopsy acquistion. Finally, endoscopic ultrasonography (EUS) complements endoscopic and percutaneous approaches and may provide a tissue diagnosis of tumors in the biliary region through fine-needle aspiration. In the future, new techniques allowing for early detection, including molecular markers, should be developed to improve the diagnostic sensitivity in this increasing tumor entity.
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Weber A, Weyhern CV, Fend F, Schneider J, Neu B, Meining A, Weidenbach H, Schmid RM, Prinz C. Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma. World J Gastroenterol 2008; 14:1097-101. [PMID: 18286693 PMCID: PMC2689414 DOI: 10.3748/wjg.14.1097] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the sensitivity of brush cytology and forceps biopsy in a homogeneous patient group with hilar cholangiocarcinoma.
METHODS: Brush cytology and forceps biopsy were routinely performed in patients with suspected malignant biliary strictures. Fifty-eight consecutive patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) including forceps biopsy and brush cytology in patients with hilar cholangiocarcinoma between 1995-2005.
RESULTS: Positive results for malignancy were obtained in 24/58 patients (41.4%) by brush cytology and in 31/58 patients (53.4%) by forceps biopsy. The combination of both techniques brush cytology and forceps biopsy resulted only in a minor increase in diagnostic sensitivity to 60.3% (35/58 patients). In 20/58 patients (34.5%), diagnosis were obtained by both positive cytology and positive histology, in 11/58 (19%) by positive histology (negative cytology) and only 4/58 patients (6.9%) were confirmed by positive cytology (negative histology).
CONCLUSION: Brush cytology and forceps biopsy have only limited sensitivity for the diagnosis of malignant hilar tumors. In our eyes, additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings.
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