title: Improving the diagnostic yield of single-operator cholangioscopy-guided biopsy of indeterminate biliary strictures: ROSE to the rescue? (with video).
abstract: OBJECTIVE
  Tissue diagnosis, regardless of technique or endoscope used, can be challenging in patients with indeterminate biliary strictures (IDBSs). This exploratory study evaluated the utility and role of rapid onsite evaluation of touch imprint cytology (ROSE-TIC) when single-operator cholangioscopy (SOC)-guided biopsies of IDBSs are performed.
  
  
  METHODS
  Patients with IDBSs were evaluated by intraprocedural ROSE-TIC during SOC-guided biopsy procedures. Final diagnosis was established by long-term patient follow-up in conjunction with off-site findings or surgical histology. The main outcome measure was to evaluate the utility of ROSE-TIC by determination of its operating characteristics and comparison with off-site histologic assessment.
  
  
  RESULTS
  Of 31 patients with IDBSs, tissue diagnosis was indeterminate at prior ERCP-guided brush and/or biopsy in 14, prior EUS-guided FNA (EUS-FNA) in 6, and a mass could not be identified at EUS in 11. The mean number of biopsies performed was 3.3 (range 1-8), and diagnostic interpretation by ROSE-TIC was diagnostic and/or suspicious for carcinoma in 15, benign in 13, atypical-reactive in 2, and bile duct intraductal papillary mucinous neoplasm in 1. Final diagnosis by surgical histology (n = 4), death by disease (n = 10), and patient follow-up (n = 17) showed that the overall sensitivity of ROSE-TIC for diagnosing malignancy was 100%, specificity 88.9%, positive predictive value 86.7%, negative predictive value 100%, and diagnostic accuracy 93.5%.
  
  
  CONCLUSIONS
  Preliminary data suggest that the diagnostic outcomes of SOC-guided biopsies in IDBSs can be significantly improved by using ROSE-TIC. This technique also may benefit centers that rely mainly on fluoroscopy-guided intraductal biopsies.
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.affiliation: Divison of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Bang
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Muhammad K
authors.initials: MK
authors.lastname: Hasan
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hawes
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Shantel
authors.initials: S
authors.lastname: Hebert-Magee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D001706:Biopsy / Q000379:methods*; D018281:Cholangiocarcinoma / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult