title: Percutaneous transhepatic cholangiographic endobiliary forceps biopsy versus endoscopic ultrasound fine needle aspiration for proximal biliary strictures: a single-centre experience.
abstract: Endoscopic ultrasound fine needle aspiration (EUS-FNA) and percutaneous transhepatic cholangiographic endobiliary forceps biopsy (PTC-EFB) are valid procedures for histological assessment of proximal biliary strictures (PBS), but their performances have never been compared. This study aimed to compare the diagnostic performance of these two techniques.
  
  
  
  The diagnostic performances of EUS-FNA and PTC-EFB were compared in a retrospective cohort of patients assessed for PBS from 2011 to 2015 at a single tertiary centre. An inverse probability of treatment weighting (IPTW) was performed to adjust for covariate imbalance.
  
  
  
  A total of 102 EUS-FNAs and 75 PTC-EFBs (performed in 137 patients) were compared. Patients in the PTC-EFB group had higher preoperative bilirubin (243 versus 169 μmol/l, p = 0.005) and a higher incidence of malignancy (87% versus 67%, p = 0.008). Both techniques showed specificity and positive predictive value of 100%, and similar sensitivity (69% versus 75%, p = 0.45), negative predictive value (58% versus 38%, p = 0.15) and accuracy (78% versus 79%, p = 1.00). After IPTW, the diagnostic performance of the two techniques remained similar.
  
  
  
  Compared to EUS-FNA, PTC-EFB provides similar sensitivity, negative predictive value and accuracy. It should therefore be considered as the preferred tissue-sampling procedure, if biliary drainage is indicated.
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom.
authors.forename: Kayvan
authors.initials: K
authors.lastname: Mohkam
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom.
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Malik
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom.
authors.forename: Carlos
authors.initials: C
authors.lastname: Derosas
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Isaac
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom.
authors.forename: Ravi
authors.initials: R
authors.lastname: Marudanayagam
authors.affiliation: Department of Interventional Radiology, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom.
authors.forename: Homoyoon
authors.initials: H
authors.lastname: Mehrzad
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom.
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom.
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Roberts
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, United Kingdom. Electronic address: robert.sutcliffe@uhb.nhs.uk.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sutcliffe
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000473:pathology*; D002758:Cholangiography / Q000009:adverse effects; D002779:Cholestasis / Q000473:pathology*; D003251:Constriction, Pathologic; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects; D004739:England; D004867:Equipment Design; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013525:Surgical Instruments; D062606:Tertiary Care Centers