FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1567223828> ?p ?o ?g. }

• W1567223828 endingPage "155" @default.
• W1567223828 startingPage "154" @default.
• W1567223828 abstract "The pathological diagnosis of bile duct cancer by non-surgical methods remains problematic. Intrahepatic bile duct cancer is more commonly diagnosed by cross-sectional imaging studies, whereas extrahepatic bile duct cancer or bile duct cancer at the level of the biliary confluence (hilar cancer) is diagnosed by cross-sectional imaging studies and endoscopic methods. The diagnosis of bile duct cancer is often considered by the presence of bile duct wall thickening, bile duct dilatation, bile duct mass, or bile duct stricture demonstrated by cross-imaging study, or endoscopically by ultrasound (EUS), intraductal ultrasound (IDUS) and by endoscopic retrograde cholangiography (ERC). Endoscopically, tissue can only be obtained by EUS or by ERC. At the time of ERC, tissue is acquired by carrying out bile exfoliative cytology, brush cytology, needle aspiration, fluoroscopy-guided biopsies and choledochoscopy-guided biopsies. The aspiration of bile and brush cytology has relatively low sensitivity and negative predictive value. Modifications to these techniques by scraping tissue, balloon dilatation, number of passes of the brush, and modifications to the brush have all been reported to increase the yield of aspiration and brush cytology. The combination of exfoliative, brush cytology and biopsy has been reported to increase the diagnostic accuracy. In this issue, Nishikawa et al.1 present their retrospective data on endoscopic transpapillary tissue sampling in a cohort of 101 patients with confirmed bile duct cancer. The data were collected from 2006 to 2011. The sampling was obtained during endoscopic retrograde cholangiopancreatography (ERCP) by aspiration cytology, brush cytology and fluoroscopic-guided forceps biopsy. Not all patients underwent all methods; aspiration cytology was carried out 238 times in 77 patients; brush cytology was carried out 67 times in 60 patients; and fluoroscopic forceps biopsy was carried out 64 times in 53 patients. The tissue samples were obtained during the index procedure by aspiration cytology and brushing cytology. If the diagnosis was not confirmed but suspected to be malignant, then additional brush cytology and fluoroscopy-guided forceps biopsies were obtained. Brush cytology was carried out using 10–11.5-mm-long brushes, moved 10 times the length of the stricture. Biopsies were done with 2.3-mm- and 1.92-mm-cup forceps. A mean of two specimens were obtained at each time. Aspiration cytology was done prior to brush or biopsy acquisition. The authors classified the lesions as flat (infiltrating), nodular (mass) and papillary (intraductal) according to the Japanese Society of Biliary Surgery.2 In this study, we do not know the location of the strictures. Considering that the most common bile duct cancer is localized to the biliary confluence (approximately 80% of cases) with extrahepatic being the second most common, perhaps we can safely assume that most of the lesions were not intrahepatic. The pathologists assessing the specimens were not blinded to the clinical data. Subgroup analysis included age (<60 or >60 years), sex, location (extrahepatic or hilar/intrahepatic), length (<15 or >15 mm), and gross appearance (flat or non-flat). The final malignant diagnosis was obtained either by pathological confirmation or by clinical follow up of at least 1 year. Bile duct cancer was established in 101 patients from the original group of 179 patients. Of the 101 patients, confirmed pathological cancer was established in 77 patients and clinically in 24 patients. Benignity of the lesion was established by an uneventful clinical course over 1 year in 54 patients. The authors found that aspiration cytology was significantly more accurate for lesions >15 mm (30% vs 18.1%); there was a tendency for increased accuracy for extrahepatic lesions (28.8% vs 18.0%), albeit not statistically significant. Brush cytology was significantly more accurate for non-flat lesions, 58.1% versus 37.5%, and had a tendency for increased accuracy for longer lesions, 61% versus 34.6%, but not statistically significant. Fluoroscopy-guided biopsy forceps was significantly more accurate for non-flat lesions, 60% versus 33.3% and tended to be more accurate for longer lesions, 56.8% versus 35%, a non-statistically significant difference. This study points out the difficulties faced during endoscopic transpapillary sampling of bile duct lesions. The methods used to obtain tissue samples are the same used in most endoscopy units worldwide and the accessories used are standard. In this study, aspiration cytology was done prior to brushing. It is known that the yield of aspiration or exfoliative cytology is greater after epithelial disruption with the brush, possibly by balloon dilation and by scraping the lesion,3 which also increases sensitivity for cellular adequacy. In general, the accuracy of aspiration (salvage)/exfoliative cytology is low and in many endoscopy units not carried out (also to avoid added cost). Brush cytology has a wide sensitivity ranging from 26% to 80% and a specificity of 83–100% for bile duct cancer.4 The results found in the study by Nishikawa et al.1 are representative of the results noted in the literature. Even for lesions in which one would expect better results, such as non-flat lesions and long lesions, their accuracy was low at 58.1–61%. In hilar cholangiocarcinoma, the yield of brush cytology is decreased either because of absent luminal tissue or by the inability to reliably advance the brush the length of the stricture. Fluoroscopy-guided biopsy forceps have a sensitivity of 30–89% and a specificity of 97–100% reported for bile duct cancer.4 It is recommended that three to four samples at least be obtained to avoid false negatives.5 Carrying out fluoroscopy-guided biopsies can be technically demanding, especially for hilar lesions, and may not be possible for intrahepatic lesions. In addition, the cholangiographic stricture may not be representative of the tumor itself but rather desmoplasia and, over the length of the procedure, contrast leaves the bile duct making further location of the lesion more difficult for subsequent biopsies. The results from Nishikawa et al.1 are in keeping with the results of the literature. The diagnosis of bile duct malignancy can be elusive. Cholangiography in conjunction with the patient's clinical presentation can be strong predictors of malignancy. Additional techniques such as endoscopic ultrasound, cholangioscopy and more advanced cytological studies are not widely available. The use of cholangioscopy and directed biopsies is particularly useful as it can be carried out for most types of cholangiocarcinoma and for most locations within the biliary tree, unless too peripheral in the intrahepatics. The study by Nishikawa et al.1 provides further insight in lesion characteristics that can predict a better yield of aspiration and brush cytology as well as fluoroscopy-guided biopsies. Their results are not better than those already established in the literature. This study demonstrates the difficulties in making a pathological diagnosis, the ultimate proof of the disease, and one that most oncologists and surgeons want to have prior to therapy." @default.
• W1567223828 created "2016-06-24" @default.
• W1567223828 creator A5066197112 @default.
• W1567223828 date "2014-03-01" @default.
• W1567223828 modified "2023-10-18" @default.
• W1567223828 title "Endoscopic tissue sampling of the bile duct: Can we do better?" @default.
• W1567223828 cites W1670149158 @default.
• W1567223828 cites W1880275018 @default.
• W1567223828 cites W1908778558 @default.
• W1567223828 cites W1978650518 @default.
• W1567223828 doi "https://doi.org/10.1111/den.12181" @default.
• W1567223828 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/24581001" @default.
• W1567223828 hasPublicationYear "2014" @default.
• W1567223828 type Work @default.
• W1567223828 sameAs 1567223828 @default.
• W1567223828 citedByCount "2" @default.
• W1567223828 countsByYear W15672238282022 @default.
• W1567223828 crossrefType "journal-article" @default.
• W1567223828 hasAuthorship W1567223828A5066197112 @default.
• W1567223828 hasBestOaLocation W15672238281 @default.
• W1567223828 hasConcept C106131492 @default.
• W1567223828 hasConcept C126322002 @default.
• W1567223828 hasConcept C140779682 @default.
• W1567223828 hasConcept C2779777945 @default.
• W1567223828 hasConcept C2910372796 @default.
• W1567223828 hasConcept C31972630 @default.
• W1567223828 hasConcept C41008148 @default.
• W1567223828 hasConcept C61434518 @default.
• W1567223828 hasConcept C71924100 @default.
• W1567223828 hasConceptScore W1567223828C106131492 @default.
• W1567223828 hasConceptScore W1567223828C126322002 @default.
• W1567223828 hasConceptScore W1567223828C140779682 @default.
• W1567223828 hasConceptScore W1567223828C2779777945 @default.
• W1567223828 hasConceptScore W1567223828C2910372796 @default.
• W1567223828 hasConceptScore W1567223828C31972630 @default.
• W1567223828 hasConceptScore W1567223828C41008148 @default.
• W1567223828 hasConceptScore W1567223828C61434518 @default.
• W1567223828 hasConceptScore W1567223828C71924100 @default.
• W1567223828 hasIssue "2" @default.
• W1567223828 hasLocation W15672238281 @default.
• W1567223828 hasLocation W15672238282 @default.
• W1567223828 hasOpenAccess W1567223828 @default.
• W1567223828 hasPrimaryLocation W15672238281 @default.
• W1567223828 hasRelatedWork W1741335765 @default.
• W1567223828 hasRelatedWork W2059929660 @default.
• W1567223828 hasRelatedWork W2357159705 @default.
• W1567223828 hasRelatedWork W2417725693 @default.
• W1567223828 hasRelatedWork W2425886291 @default.
• W1567223828 hasRelatedWork W2510775345 @default.
• W1567223828 hasRelatedWork W291327325 @default.
• W1567223828 hasRelatedWork W3029073180 @default.
• W1567223828 hasRelatedWork W4234712306 @default.
• W1567223828 hasRelatedWork W4386575841 @default.
• W1567223828 hasVolume "26" @default.
• W1567223828 isParatext "false" @default.
• W1567223828 isRetracted "false" @default.
• W1567223828 magId "1567223828" @default.
• W1567223828 workType "article" @default.