Usefulness of cholangioscopic-guided mapping biopsy using SpyGlass DS for preoperative evaluation of extrahepatic cholangiocarcinoma: a pilot study

Abstract Background and study aims Evaluation of longitudinal tumor extent is indispensable for curative surgical treatment of extrahepatic cholangiocarcinoma. The aim of this study was to evaluate the usefulness and feasibility of cholangioscopic-guided mapping biopsy using a newly developed peroral digital cholangioscope, SpyGlass DS (SpyDS), for preoperative evaluation of extrahepatic cholangiocarcinoma. Patients and methods Thirteen patients (mean age, 75 years; male 10, female 3) with extrahepatic cholangiocarcinoma who underwent cholangioscopic-guided mapping biopsy using SpyDS for preoperative evaluation were included in this study. Successful cholangioscopic-guided mapping biopsy was defined as the acquisition of specimens sufficient for histopathological diagnosis. Results The mean number of biopsies was 5 per patient. The overall success rate for cholangioscopic-guided mapping biopsy was 88 % (59/67). The success rate for cholangioscopic-guided mapping biopsy from the confluence of the right and left hepatic ducts was 89 %, that from the B4 confluence was 93 %, that from the confluence of the right anterior and right posterior segmental ducts was 86 %, that from the intrapancreatic common bile duct was 67 %, and that from the main lesion was 100 %. The overall diagnostic accuracy of longitudinal tumor extent at the hepatic side, the duodenal side and overall by cholangioscopic findings and mapping biopsy, was 88 % (7/8), 88 % (7/8) and 88 % (7/8), respectively. Assessment according to location of the main lesion revealed that diagnostic accuracy in the patients with distal bile duct carcinoma was 100 % (5/5) and that in patients with perihilar bile duct carcinoma was 66 % (2/3). Complications after the procedure did not occur in any patients. Conclusions Cholangioscopic-guided mapping biopsy using SpyDS is thought to be feasible for preoperative evaluation of extrahepatic cholangiocarcinoma.

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Tu1431 Usefulness of Cholangioscopic Guided Mapping Biopsy Using Spyglass DS for Preoperative Evaluation of Extrahepatic Cholangiocarcinoma: A Pilot Study

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.1438 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB624 ◽

Cited By ~ 1

Author(s):

Takahisa Ogawa ◽

Kei Ito ◽

Shinsuke Koshita ◽

Yoshihide Kanno ◽

Kaori Masu ◽

...

Keyword(s):

Pilot Study ◽

Preoperative Evaluation ◽

Extrahepatic Cholangiocarcinoma ◽

Spyglass Ds ◽

Mapping Biopsy

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A novel technique for endoscopic transpapillary “mapping biopsy specimens” of superficial intraductal spread of bile duct carcinoma (with videos)

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2014.01.040 ◽

2014 ◽

Vol 79 (6) ◽

pp. 1020-1025 ◽

Cited By ~ 10

Author(s):

Susumu Hijioka ◽

Kazuo Hara ◽

Nobumasa Mizuno ◽

Hiroshi Imaoka ◽

Mohamed A. Mekky ◽

...

Keyword(s):

Bile Duct ◽

Bile Duct Carcinoma ◽

Duct Carcinoma ◽

Intraductal Spread ◽

Novel Technique ◽

Biopsy Specimens ◽

Mapping Biopsy

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Role of biliary CEACAM6 as a biomarker for cholangiocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.177 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 177-177

Author(s):

John B. Rose ◽

Camilo Correa-Gallego ◽

James Nelson ◽

Adnan Alseidi ◽

Scott Helton ◽

...

Keyword(s):

Logistic Regression ◽

Bile Duct ◽

Roc Curve ◽

Bile Duct Carcinoma ◽

Surface Protein ◽

Enzyme Linked Immunosorbent Assay ◽

Biliary Disease ◽

Roc Curve Analysis ◽

Extrahepatic Cholangiocarcinoma ◽

Duct Carcinoma

177 Background: Distinguishing bile duct carcinoma from other diagnoses is often difficult using endoscopic or percutaneous techniques. The cell surface protein CEACAM6 is over-expressed in many gastrointestinal cancers and may be selectively elevated in biliary adenocarcinoma. The aim of the present study is to determine if CEACAM6 can be detected in the bile of patients with biliary cancer and can serve as a diagnostic biomarker for cholangiocarcinoma. Methods: Bile duct and gallbladder bile from patients with benign biliary disease and cholangiocarcinoma (hilar, intrahepatic and distal) was collected at the time of index operation. The concentration of CEACAM6 was quantified by sandwich enzyme-linked immunosorbent assay (ELISA) and correlated to pathologic diagnosis. Diagnostic capability of CEACAM6 was evaluated by Wilcoxon rank-sum, logistic regression, and receiver operating characterisitic (ROC) curve analysis. Results: Bile from 73 patients was analyzed: 40 with benign disease and 33 with cholangiocarcinoma. Patients in the benign cohort were younger, predominantly female, and had lower mean biliary CEACAM6 levels than patients in the malignant cohort (102 ng/ml vs. 239 ng/ml; p=0.0006). Logistic regression analysis determined CEACAM6 to be a positive predictor of extrahepatic but not intrahepatic cholangiocarcinoma (p=0.0015). ROC curve with a CEACAM6 level >22.1 ng/ml was associated with 85% sensitivity, 73% specificity, and a likelihood ratio of 3.15 (AUC 0.82) for extrahepatic cholangiocarcinoma. Conclusions: CEACAM6 levels in bile can predict patients with extrahepatic cholangiocarcinoma with acceptable accuracy. Further investigation is warranted in a larger cohort of patients prior to clinical application.

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