title: Endoscopic ultrasound-guided fine needle aspiration biopsy of suspected cholangiocarcinoma.
abstract: OBJECTIVE
  Despite advances in endoscopic techniques for sampling bile duct strictures, the diagnosis of cholangiocarcinoma remains a challenge. The purpose of this study was to evaluate the yield of EUS-FNA and its impact on patient management for patients with suspected cholangiocarcinoma.
  
  
  METHODS
  All patients undergoing EUS for the evaluation of suspected malignant biliary strictures were prospectively evaluated over a 23-month period. A single gastroenterologist performed all EUS-FNAs in the presence of a cytopathologist. Reference standard for final diagnosis included surgery, death from disease, and clinical and/or imaging follow-up.
  
  
  RESULTS
  Twenty-eight patients (mean age 67 years [SD +/- 11], 72% male) were evaluated. Most patients (91%) presented with obstructive jaundice, and all except 1 had nondiagnostic sampling of the biliary lesions either at ERCP (88%), percutaneous transhepatic cholangiogram (n = 2), and/or computed tomography-guided biopsy (n = 1). Sixty-seven percent (14/21) had no definitive mass seen on prior abdominal imaging studies. The mean tumor size by EUS was 19 mm x 16 mm with a median number of passes to diagnosis of 3 (range 1-7). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86%, 100%, 100%, 57%, and 88%, respectively. EUS-FNA had a positive impact on patient management in 84% of patients: preventing surgery for tissue diagnosis in patients with inoperable disease (n = 10), facilitating surgery in patients with unidentifiable cancer by other modalities (n = 8), and avoiding surgery in benign disease (n = 4).
  
  
  CONCLUSIONS
  Given the apparent accuracy and safety of EUS with FNA for imaging bile duct mass lesions and for obtaining a tissue diagnosis in patients with suspected cholangiocarcinoma, this technology may represent a new approach to diagnosis especially when other methods fail. The ability to obtain a definite diagnosis has a significant impact on patient management.
authors.affiliation: Departments of Gastroenterology and Hepatology, University of Alabama at Birmingham, Alabama 35294-0007, USA. meloubeidi@uabmc.edu
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Eloubeidi
authors.forename: Victor K
authors.initials: VK
authors.lastname: Chen
authors.forename: Nirag C
authors.initials: NC
authors.lastname: Jhala
authors.forename: Isam E
authors.initials: IE
authors.lastname: Eltoum
authors.forename: Darshana
authors.initials: D
authors.lastname: Jhala
authors.forename: David C
authors.initials: DC
authors.lastname: Chhieng
authors.forename: Sujath A
authors.initials: SA
authors.lastname: Syed
authors.forename: Selwyn M
authors.initials: SM
authors.lastname: Vickers
authors.forename: C
authors.initials: C
authors.lastname: Mel Wilcox
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic; D001707:Biopsy, Needle / Q000379:methods*; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D016001:Confidence Intervals; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity