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

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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.

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Funding

This study has not been funded by external/internal funds.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    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

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  1. Karan Kaura
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  2. Tarek Sawas
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  3. Fateh Bazerbachi
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Correspondence to Vinay Chandrasekhara.

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Conflict of interest

Dr. Vinay Chandrasekhara has stock ownership in Nevakar corporation and is a member of the Medical Advisory Board for Interpace Diagnostics. Dr. Bret T. Petersen is a consultant for Boston Scientific and consults for Olympus and GI medical. Dr. Barham K. Abu Dayyeh receives research support for Boston Scientific and is a speaker for Olympus. Dr. Andrew C. Storm receives research support for Boston Scientific.

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Kaura, K., Sawas, T., Bazerbachi, F. et al. Cholangioscopy Biopsies Improve Detection of Cholangiocarcinoma When Combined with Cytology and FISH, but Not in Patients with PSC. Dig Dis Sci 65, 1471–1478 (2020). https://doi.org/10.1007/s10620-019-05866-2

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  • DOI: https://doi.org/10.1007/s10620-019-05866-2

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