title: A novel method of forceps biopsy improves the diagnosis of proximal biliary malignancies.
abstract: OBJECTIVE
  Tissue specimen collection represents a cornerstone in diagnosis of proximal biliary tract malignancies offering great specificity, but only limited sensitivity. To improve the tumor detection rate, we developed a new method of forceps biopsy and compared it prospectively with endoscopic transpapillary brush cytology.
  
  
  METHODS
  43 patients with proximal biliary stenoses, which were suspect for malignancy, undergoing endoscopic retrograde cholangiography were prospectively recruited and subjected to both biopsy [using a double-balloon enteroscopy (DBE) forceps under a guidance of a pusher and guiding catheter with guidewire] and transpapillary brush cytology. The cytological/histological findings were compared with the final clinical diagnosis.
  
  
  RESULTS
  35 out of 43 patients had a malignant disease (33 cholangiocarcinomas, 1 hepatocellular carcinoma, 1 gallbladder carcinoma). The sensitivity of cytology and biopsy in these patients was 49 and 69%, respectively. The method with DBE forceps allowed a pinpoint biopsy of the biliary stenoses. Both methods had 100% specificity, and, when combined, 80% of malignant processes were detected. All patients with non-malignant conditions were correctly assigned by both methods. No clinically relevant complications were observed.
  
  
  CONCLUSIONS
  The combination of forceps biopsy and transpapillary brush cytology is safe and offers superior detection rates compared to both methods alone, and therefore represents a promising approach in evaluation of proximal biliary tract processes.
authors.affiliation: Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Ulm, Germany. Hasan.Kulaksiz@uniklinik-ulm.de
authors.forename: Hasan
authors.initials: H
authors.lastname: Kulaksiz
authors.forename: Pavel
authors.initials: P
authors.lastname: Strnad
authors.forename: Achim
authors.initials: A
authors.lastname: Römpp
authors.forename: Guido
authors.initials: G
authors.lastname: von Figura
authors.forename: Thomas
authors.initials: T
authors.lastname: Barth
authors.forename: Irene
authors.initials: I
authors.lastname: Esposito
authors.forename: Peter
authors.initials: P
authors.lastname: Schirmacher
authors.forename: Doris
authors.initials: D
authors.lastname: Henne-Bruns
authors.forename: Guido
authors.initials: G
authors.lastname: Adler
authors.forename: Adolf
authors.initials: A
authors.lastname: Stiehl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D001706:Biopsy / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D018281:Cholangiocarcinoma / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005704:Gallbladder / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis*; D008875:Middle Aged; D013525:Surgical Instruments; D055815:Young Adult