title: Diagnostic yield of endoscopic retrograde cholangiography and of EUS-guided fine needle aspiration sampling in gallbladder carcinomas.
abstract: BACKGROUND
  Obtaining histological evidence of gallbladder carcinoma (GBC) is difficult due to its extraductal nature, and pathological confirmation remains challenging. We compared the diagnostic value and safety of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with endoscopic retrograde cholangiography (ERC) in patients with suspected GBC.
  
  
  METHODS
  Eighty-three patients with GBC were evaluated. Prior to definitive management, pathological evidence of GBC was obtained through either ERC cytopathologic sampling (n = 33), EUS-FNA (n = 24) or both (n = 26).
  
  
  RESULTS
  Among the 83 patients, 59 (71.0%) with biliary obstruction were sampled using ERC with 47.4% (28/59) sensitivity. In 19 of the remaining 31 cases, EUS-FNA sampling had 100% diagnostic sensitivity. Likewise, 50 (60.2%) of the 83 patients with suspected GBC underwent EUS-FNA of regional lymph nodes or the gallbladder (GB) mass itself with 94.8% sensitivity. The overall diagnostic sensitivity rates of ERC and EUS-FNA were 47.4 and 96%, respectively (P < 0.001). Post-procedural complications were seen in 6.7% of the ERC group (4/59, all were mild pancreatitis), and in none of the EUS-FNA group (P = 0.10).
  
  
  CONCLUSIONS
  Gallbladder carcinoma sampling using ERC and EUS-FNA should be incorporated into the diagnostic workup of GB lesions as complementary tools, and EUS-FNA should be applied in the setting of failed or not indicated ERC.
authors: Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan. rizasusu@aichi-cc.jp
authors: Susumu
authors: S
authors: Hijioka
authors: Kazuo
authors: K
authors: Hara
authors: Nobumasa
authors: N
authors: Mizuno
authors: Hiroshi
authors: H
authors: Imaoka
authors: Takeshi
authors: T
authors: Ogura
authors: Shin
authors: S
authors: Haba
authors: Mohamed A
authors: MA
authors: Mekky
authors: Vikram
authors: V
authors: Bhatia
authors: Waki
authors: W
authors: Hosoda
authors: Yasushi
authors: Y
authors: Yatabe
authors: Yasuhiro
authors: Y
authors: Shimizu
authors: Yasumasa
authors: Y
authors: Niwa
authors: Masahiro
authors: M
authors: Tajika
authors: Shinya
authors: S
authors: Kondo
authors: Tsutomu
authors: T
authors: Tanaka
authors: Kiichi
authors: K
authors: Tamada
authors: Kenji
authors: K
authors: Yamao
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D003937:Diagnosis, Differential; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies