title: Cholangiopancreatoscopy and endoscopic ultrasound for indeterminate pancreaticobiliary pathology.
abstract: BACKGROUND
  Techniques to confirm suspected pancreaticobiliary (PB) malignancy when index sampling is non-diagnostic include cholangiopancreatoscopy (CP) and endoscopic ultrasound (EUS). However, comparative data are lacking.
  
  
  OBJECTIVE
  The purpose of this study was to compare the yield of EUS and CP for the diagnosis of PB pathology.
  
  
  METHODS
  Consecutive patients with indeterminate PB pathology who underwent both CP and EUS within 3 months of each other were retrospectively identified. For CP, tissue sampling included biopsy under direct inspection (cholangioscopy-directed biopsy), biopsy following CP with fluoroscopic guidance (cholangioscopy-assisted biopsy), or brush cytology. For EUS-FNA, lesions included ductal strictures or hypoechoic masses. A comparison of operating characteristics between CP and EUS utilizing tissue confirmation or 12-month clinical course consistent with either benign or malignant disease was performed.
  
  
  RESULTS
  Between February 2000 and June 2007, 66 (33 males, 33 females, median age 64.5) patients with indeterminate PB pathology who had undergone both CP and EUS within 3 months of each other were included. Lesions amenable to sampling were noted in 59 CP and 50 EUS patients. On follow-up, 39 patients had neoplasia and 27 were benign. The sensitivity/specificity for the diagnosis of neoplasia for CP and EUS was 48.7/96.3 % and 33.3/96.3 %, respectively (comparison of sensitivities, P = 0.183). The combined (CP and EUS) sensitivity/specificity was 66.7/96.3 % (P = 0.0064 and P = 0.0001 comparing combined sensitivity vs. sensitivity of either CP alone or EUS alone, respectively).
  
  
  CONCLUSIONS
  In patients who undergo both EUS and CP for indeterminate PB pathology, the combined yield of EUS and CP to detect neoplasia appears to be higher than either examination alone.
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Abdul H
authors.initials: AH
authors.lastname: Khan
authors.forename: Greg L
authors.initials: GL
authors.lastname: Austin
authors.forename: Norio
authors.initials: N
authors.lastname: Fukami
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
authors.forename: Brian C
authors.initials: BC
authors.lastname: Brauer
authors.forename: Raj J
authors.initials: RJ
authors.lastname: Shah
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data*; D019160:Endosonography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012189:Retrospective Studies