title: Endoscopic ultrasound-guided FNA biopsy of bile duct and gallbladder: analysis of 53 cases.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreaticography (ERCP)-guided brushing has been the standard of practice for surveillance and detection of carcinoma in the biliary tree. Few studies have evaluated the role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in diagnosing clinically suspected cholangiocarcinoma. The role of this method in diagnosing clinically suspected gallbladder malignancies has not been extensively evaluated in the USA. This study investigates the role of EUS-FNA in the diagnosis of clinically suspected biliary tree and gallbladder malignancies in a large patient series.
  
  
  METHODS
  EUS-FNAs were obtained from 46 bile duct and seven gallbladder lesions. On-site rapid interpretation was provided using air-dried Diff Quik stained smears. In addition, alcohol fixed Papanicoloau stained smears and Thin Prep preparations (Cytye Corp., Marlborough, MA, USA) were evaluated before providing a final cytological diagnosis. Tissue biopsies and/or clinical follow-up were used as the standards to determine operating characteristics for EUS-FNA.
  
  
  RESULTS
  The mean ages for bile duct and gallbladder lesions were 66 years (range: 37-84 years), and 69 years (range 49-86 years), respectively. All cases diagnosed as suspicious/malignant on preliminary evaluation were confirmed on final cytological interpretation (27/27). The operating characteristics show that EUS-FNA is highly specific (100%) with sensitivity rates of 87% and 80% from clinically suspected malignancies of biliary tract and gallbladder, respectively. Sampling error in three cases and associated acute inflammation in two cases resulted in false-negative diagnoses.
  
  
  CONCLUSIONS
  EUS-FNA of biliary tree and gallbladder carcinoma is highly specific and should be considered for evaluation of clinically suspicious lesions. Marked inflammation may result in false-negative diagnoses.
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Meara
authors.forename: D
authors.initials: D
authors.lastname: Jhala
authors.forename: M A
authors.initials: MA
authors.lastname: Eloubeidi
authors.forename: I
authors.initials: I
authors.lastname: Eltoum
authors.forename: D C
authors.initials: DC
authors.lastname: Chhieng
authors.forename: D R
authors.initials: DR
authors.lastname: Crowe
authors.forename: S
authors.initials: S
authors.lastname: Varadarajulu
authors.forename: N
authors.initials: N
authors.lastname: Jhala
mesh_terms: D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology; D044963:Biopsy, Fine-Needle / Q000379:methods*; D019160:Endosonography / Q000379:methods; D005189:False Positive Reactions; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D006801:Humans; D011446:Prospective Studies; D012680:Sensitivity and Specificity