PMID- 32430658 OWN - NLM STAT- MEDLINE DCOM- 20210816 LR - 20221111 IS - 1573-2568 (Electronic) IS - 0163-2116 (Linking) VI - 66 IP - 4 DP - 2021 Apr TI - Combination of ERCP-Based Modalities Increases Diagnostic Yield for Biliary Strictures. PG - 1276-1284 LID - 10.1007/s10620-020-06335-x [doi] AB - BACKGROUND: Biliary stricture evaluation with brush cytology and intraductal forceps biopsy carries a low sensitivity, but the combination of newer modalities may improve sensitivity. AIM: To determine whether the addition of advanced modalities increases diagnostic yield of ERCP-based sampling. METHODS: This single-center retrospective study evaluates patients with biliary strictures sampled using brush cytology. Operating characteristics were calculated for individual and combinations of modalities including cholangioscopy, fluoroscopy- and cholangioscopy-directed intraductal biopsy, fluorescence in situ hybridization (FISH), and confocal laser endomicroscopy. Analyses under Standard Criteria (SC) included malignant results as "positive" and Expanded Criteria (EC) included "suspicious" and "high-grade dysplasia" results as "positive." RESULTS: A total of 614 patients were included, and 354 (57.8%) received brush cytology alone, which had a sensitivity of 38.5% (SC) to 40.3% (EC) and a specificity of 97.8% (EC) to 99.3% (SC). Combining brush cytology with fluoroscopy-guided biopsy (n = 259, 42.2%) had a sensitivity of 62.5% (SC) to 67.9% (EC) and specificity of 90.2% (EC) to 96.7% (SC). Adding FISH to brush cytology had a sensitivity of 84.2% (SC) to 87.5% (EC) and specificity of 54.1% (SC and EC), while cholangioscopy visualization addition resulted in a sensitivity of 80.4% (SC) to 92.2% (EC) and specificity of 67.3% (EC) to 89.1% (SC). There were no significant differences in sensitivity and specificity using SC and EC. CONCLUSIONS: Brush cytology has a low sensitivity, but the addition of other modalities increases sensitivity. There was no difference in specificity between the SC and the EC, supporting the inclusion of "suspicious" impressions with malignant results at our center. FAU - Han, Samuel AU - Han S AD - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Ct, Rm. AIP 2.031, Aurora, CO, 80045, USA. FAU - Tatman, Philip AU - Tatman P AD - Medical Scientist Training Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. FAU - Mehrotra, Sanjana AU - Mehrotra S AD - Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. FAU - Wani, Sachin AU - Wani S AD - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Ct, Rm. AIP 2.031, Aurora, CO, 80045, USA. FAU - Attwell, Augustin R AU - Attwell AR AD - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Ct, Rm. AIP 2.031, Aurora, CO, 80045, USA. FAU - Edmundowicz, Steven A AU - Edmundowicz SA AD - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Ct, Rm. AIP 2.031, Aurora, CO, 80045, USA. FAU - Brauer, Brian C AU - Brauer BC AD - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Ct, Rm. AIP 2.031, Aurora, CO, 80045, USA. FAU - Wagh, Mihir S AU - Wagh MS AD - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Ct, Rm. AIP 2.031, Aurora, CO, 80045, USA. FAU - Hammad, Hazem T AU - Hammad HT AD - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Ct, Rm. AIP 2.031, Aurora, CO, 80045, USA. FAU - Shah, Raj J AU - Shah RJ AUID- ORCID: 0000-0002-9736-4139 AD - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Ct, Rm. AIP 2.031, Aurora, CO, 80045, USA. Raj.Shah@ucdenver.edu. LA - eng GR - T32 GM007635/GM/NIGMS NIH HHS/United States GR - T32 DK007038/DK/NIDDK NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20200519 PL - United States TA - Dig Dis Sci JT - Digestive diseases and sciences JID - 7902782 SB - IM MH - Adenocarcinoma/diagnostic imaging/pathology/surgery MH - Adult MH - Aged MH - Bile Duct Neoplasms/diagnostic imaging/pathology/surgery MH - Cholangiopancreatography, Endoscopic Retrograde/*methods MH - Cholestasis/*diagnostic imaging/*pathology/surgery MH - Constriction, Pathologic/diagnostic imaging/pathology MH - Cytodiagnosis/*methods MH - Female MH - Humans MH - In Situ Hybridization, Fluorescence/*methods MH - Male MH - Microscopy, Confocal/methods MH - Middle Aged MH - Pancreatic Neoplasms/diagnostic imaging/pathology/surgery MH - Retrospective Studies OTO - NOTNLM OT - Biliary strictures OT - Cholangioscopy OT - Confocal laser endomicroscopy OT - ERCP OT - Fluorescence in situ hybridization EDAT- 2020/05/21 06:00 MHDA- 2021/08/17 06:00 CRDT- 2020/05/21 06:00 PHST- 2019/12/24 00:00 [received] PHST- 2020/05/08 00:00 [accepted] PHST- 2020/05/21 06:00 [pubmed] PHST- 2021/08/17 06:00 [medline] PHST- 2020/05/21 06:00 [entrez] AID - 10.1007/s10620-020-06335-x [pii] AID - 10.1007/s10620-020-06335-x [doi] PST - ppublish SO - Dig Dis Sci. 2021 Apr;66(4):1276-1284. doi: 10.1007/s10620-020-06335-x. Epub 2020 May 19.