title: Intraductal biopsies in indeterminate biliary stricture: Evaluation of histopathological criteria in fluoroscopy- vs. cholangioscopy guided technique.
abstract: BACKGROUND
  Differentiating malignancy from benign disease in indeterminate biliary stricture by imaging modalities is limited. Definite diagnosis relies on histopathological diagnosis.
  
  
  OBJECTIVE
  To assess accuracy of histopathological diagnosis of fluoroscopy-guided vs. cholangioscopy-directed intraductal biopsies in indeterminate biliary stricture.
  
  
  METHODS
  All patients with indeterminate biliary stricture and fluoroscopically (n=68) or cholangioscopy-directed (working channel 2mm, n=38) biopsies were included. Histopathological results of biopsies were classified into inflammatory lesion (class 1), dysplasia/intraepithelial neoplasia (class 2) and malignancy (class 3) and results as well as macroscopic diagnosis were compared with final diagnosis.
  
  
  RESULTS
  Sensitivity and specificity of fluoroscopy-guided vs. cholangioscopy-directed biopsies were 22.9% and 100% vs. 25.0% and 100% for class 1+2 vs. class 3 lesions, respectively. Sensitivity for class 1 vs. class 2+3 lesions was 45.7% (p=0.044) vs. 58.3% (p=0.214) for fluoroscopy-guided vs. cholangioscopy-directed biopsies, respectively, while specificity was 100% in both. There was no difference in size of the obtained sample (p=0.992). True positive diagnosis rate increased with the number of biopsies taken (p=0.028).
  
  
  CONCLUSIONS
  Fluoroscopy-guided and cholangioscopy-directed intraductal biopsies are equally limited in establishing the diagnosis of malignancy in indeterminate biliary stricture. Categorizing dysplasia or intraepithelial neoplasia as malignancy increases sensitivity without decrease in specificity. By taking more biopsies, diagnostic yield is increased.
authors.affiliation: Department of Internal Medicine I, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany(1). Electronic address: dirk.walter@kgu.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Walter
authors.affiliation: Department of Internal Medicine I, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany(1).
authors.forename: Jan
authors.initials: J
authors.lastname: Peveling-Oberhag
authors.affiliation: Dr Senckenberg Institute for Pathology, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany(2).
authors.forename: Falko
authors.initials: F
authors.lastname: Schulze
authors.affiliation: Institute of Biostatistics and Mathematical Modeling, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany(3).
authors.forename: Dimitra
authors.initials: D
authors.lastname: Bon
authors.affiliation: Department of Internal Medicine I, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany(1).
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.affiliation: Department of Internal Medicine I, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany(1).
authors.forename: Mireen
authors.initials: M
authors.lastname: Friedrich-Rust
authors.affiliation: Department of Internal Medicine I, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany(1).
authors.forename: Jörg G
authors.initials: JG
authors.lastname: Albert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D018281:Cholangiocarcinoma / Q000453:epidemiology* / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000209:etiology; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D005471:Fluoroscopy; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Cholangiocarcinoma; Cholangioscopy; Endoscopic Retrograde Cholangiopancreatography (ERCP); Endoscopy; Indeterminate biliary stricture; Intraductal biopsy