scholarly journals Advances of Peroral Cholangioscopy and EUS for Indeterminate Biliary Lesions

2020 ◽  
Vol 25 (1) ◽  
pp. 29-33
Author(s):  
Yun Nah Lee
Keyword(s):  
Diagnostic Yield ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Biliary Strictures ◽  
Diagnostic Modality ◽  
Visualization System ◽  
Technical Performance ◽  
Peroral Cholangioscopy ◽  
Tailored Approach ◽  
Spyglass Direct Visualization System

Traditionally, biliary lesions have been considered to be indeterminate when a diagnosis cannot be made after basic laboratory work-up, abdominal imaging and endoscopic retrograde cholangiopancreatography (ERCP) with biliary sampling. Although ERCP is a first-line diagnostic modality for indeterminate biliary lesions, the diagnostic yield of ERCP-based tissue sampling is insufficient. In a recent, peroral cholangioscopy (POC)- guided forceps biopsy and endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) are evolving as reliable diagnostic procedures for indeterminate biliary lesions. In previous studies, EUS-FNA was sensitive and highly specific for diagnosing malignancy in biliary strictures. However, EUS-FNA has several limitations as a routine clinical procedure for all biliary strictures. Newly developed POC systems, such as the SpyGlass direct visualization system and direct POC using an ultra-slim endoscope, have led to excessive improvements in technical performance and diagnostic yields for biliary strictures. However, the performance of POC-guided target biopsy for distal bile duct strictures is technically difficult, and this approach has a limited ability to diagnose biliary strictures caused by non-intraductal, extrinsic compressed malignancies, such as a pancreatic cancer. Therefore, a tailored approach using optimized endoscopic modalities that are specific to the characteristics of a given biliary stricture is needed to achieve a high diagnostic yield for indeterminate biliary lesions.

Tissue acquisition for diagnosis of biliary strictures using peroral cholangioscopy or endoscopic ultrasound-guided fine-needle aspiration

Endoscopy ◽  
2018 ◽  
Vol 51 (01) ◽  
pp. 50-59 ◽  
Author(s):  
Yun Lee ◽  
Jong Moon ◽  
Hyun Choi ◽  
Hee Kim ◽  
Hyun Lee ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Diagnostic Yield ◽  
Needle Aspiration ◽  
Biliary Strictures ◽  
Ultrasound Guided ◽  
Forceps Biopsy ◽  
Fine Needle ◽  
Peroral Cholangioscopy

Abstract Background Although endoscopic retrograde cholangiopancreatography (ERCP) is a first-line diagnostic modality for suspected malignant biliary stricture (MBS), the diagnostic yield of ERCP-based tissue sampling is insufficient. Peroral cholangioscopy-guided forceps biopsy (POC-FB) and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) are evolving as reliable diagnostic procedures for inconclusive MBS. This study aimed to evaluate the usefulness of a diagnostic approach using POC-FB or EUS-FNAB according to the stricture location in patients with suspected MBS. Methods Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with transpapillary forceps biopsy (TPB) was performed initially. When malignancy was not confirmed by TPB, POC-FB using a SpyGlass direct visualization system or direct POC using an ultraslim endoscope was performed for proximal strictures, and EUS-FNAB was performed for distal strictures as a follow-up biopsy. Results Among a total of 181 patients, initial TPB showed malignancy in 122 patients, and the diagnostic accuracy of initial TPB was 71.8 % (95 % confidence interval [CI] 65.3 % – 78.4 %]. Of the 59 patients in whom TPB was negative for malignancy, 32 had proximal biliary strictures and underwent successful POC. The remaining 27 patients had distal strictures and underwent successful EUS-FNAB. The accuracy of malignancy detection using POC-FB for proximal biliary strictures and EUS-FNAB for distal biliary strictures was 93.6 % (95 %CI 84.9 %−100 %) and 96.3 % (95 %CI 89.2 %−100 %), respectively. The overall diagnostic accuracy for the combination of TPB with either POC-FB for proximal strictures and EUS-FNAB for distal strictures was 98.3 % (95 %CI 95.9 %−100 %) and 98.4 % (95 %CI 95.3 %−100 %), respectively. Conclusions An approach using POC-FB or EUS-FNAB according to the stricture location may be useful in the diagnosis of suspected MBS.

Mo1316 SpyGlass® System PerOral Cholangioscopy in Indeterminate Biliary Strictures: How to Improve the Diagnostic Yield

2012 ◽  
Vol 75 (4) ◽  
pp. AB387
Author(s):  
Raffaele Manta ◽  
Emanuele Dabizzi ◽  
Helga Bertani ◽  
Mauro Manno ◽  
Vincenzo G. Mirante ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Biliary Strictures ◽  
Peroral Cholangioscopy

Diagnostic yield of conventional transbronchial needle aspiration in suspected bronchogenic carcinoma without intraluminal growth on bronchoscopy

2017 ◽  
Vol 5 (4) ◽  
pp. 1270 ◽  
Author(s):  
Davis Kizhakkepeedika Rennis ◽  
Easwaramangalath Venugopal Krishnakumar ◽  
Navmi Sankarapotti
Keyword(s):  
Bronchogenic Carcinoma ◽  
Diagnostic Yield ◽  
Tertiary Care ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Transbronchial Needle Aspiration ◽  
Ct Guided ◽  
Forceps Biopsy ◽  
Bronchial Washing ◽  
Intraluminal Mass

Background: Bronchogenic carcinoma with spread along the mucosal plane presents as an exophytic mass. Most of the submucosal and peribronchial patterns of this malignancy are harder to detect by standard diagnostic procedures such as bronchial washing, brushing and forceps biopsy. We sought to investigate the utility of transbronchial needle aspiration (TBNA) in the diagnosis of bronchogenic carcinoma without intraluminal mass, through prospective analysis of routine diagnostic bronchoscopies performed in a 24-month period, at a tertiary care hospital.Methods: Patients with suspected bronchogenic carcinoma (clinical and radiological) underwent standard computed tomography (CT) of thorax. Further the patients were subjected to conventional TBNA, singly, and in combination with bronchial washings and brushings. The results were analyzed statistically for the diagnostic yield of TBNA.Results: Among the 42 patients assessed, 29 had malignancy confirmed by forceps biopsy or CT guided Fine Needle aspiration cytology or biopsy and bronchoscopy. Among them, 17 cases were detected by a combination of the results of bronchial washing, brushing and TBNA. The individual sensitivities amounted to 3.4% (n=1), 51.72% (n=15) and 27.6% (n=8), respectively. There were no false positive results. Concerning different bronchoscopic sampling techniques, 9 cases were diagnosed solely by bronchial brushings and 2 cases by TBNA alone. No periprocedural complications were encountered.Conclusions: Value of bronchial brushing in the diagnosis of bronchogenic carcinoma without bronchoscopically visible intraluminal mass is above that of conventional TBNA. Addition of bronchial washings, to bronchial brushings and TBNA has an insignificant impact on the diagnosis.

Diagnosis and Molecular Profiling of Lung Cancer by Percutaneous Ultrasound-Guided Biopsy of Superficial Metastatic Sites Is Safe and Highly Effective

Respiration ◽  
2021 ◽  
pp. 1-8
Author(s):  
Vanina Livi ◽  
Daniela Paioli ◽  
Alessandra Cancellieri ◽  
Sara Betti ◽  
Filippo Natali ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Diagnostic Yield ◽  
Subcutaneous Tissue ◽  
Locally Advanced ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Molecular Profiling ◽  
Aspiration Biopsy ◽  
Ct Guided ◽  
Tissue Diagnosis

<b><i>Background:</i></b> Diagnosis, staging, and molecular profiling of lung cancer are mostly carried out with bronchoscopy or CT-guided aspiration/biopsy. However, patients with locally advanced or advanced disease often harbor “superficial” metastases for which a percutaneous, ultrasound-assisted needle aspiration/biopsy (US-NAB) might represent an equally effective yet less invasive and costly alternative. <b><i>Patients and Methods:</i></b> We reviewed a prospectively collected database of consecutive patients with known/suspected lung cancer who underwent a US-NAB of a suspected “superficial” metastasis. Cancer genotyping was carried out with next-generation sequencing using the Oncomine™ Focus DNA and RNA fusion panels. PD-L1 immunohistochemistry was performed with the SP263 antibody. Feasibility, diagnostic yield for tissue diagnosis, sensitivity for malignancy, diagnostic yield for the molecular profiling, and complications were the study endpoints. <b><i>Results:</i></b> A total of 98 lesions were evaluated, and 93 were biopsied (95% feasibility). The spectrum of sampled sites included lymph nodes (63 patients), bone (11), subcutaneous tissue (8), muscle (7), and the pleura (4). The diagnostic yield for a tissue diagnosis was 93% (91/98). US-NAB correctly identified 85 of the 87 patients finally diagnosed with malignancy (98% sensitivity). Cancer genotyping and PDL1 testing were successfully completed in 41/42 patients (98%) and in 40/50 patients (80%) for whom these tests were requested, respectively. No complications were observed. <b><i>Conclusion:</i></b> US-NAB of “superficial” metastasis of lung cancer is safe and is associated with high success for diagnosis and molecular profiling. In this clinical setting, using US-NAB as a first-step technique would significantly limit the use of more invasive and costly diagnostic procedures.

scholarly journals Role of Peroral Cholangioscopy for Diagnosis and Staging of Biliary Tumors

2020 ◽  
Vol 38 (5) ◽  
pp. 431-440 ◽  
Author(s):  
Pedro Pereira ◽  
Sancha Santos ◽  
Rui Morais ◽  
Rui Gaspar ◽  
Eduardo Rodrigues-Pinto ◽  
...  
Keyword(s):  
Preoperative Evaluation ◽  
Preoperative Staging ◽  
Final Diagnosis ◽  
Filling Defect ◽  
Biliary Strictures ◽  
Visualization System ◽  
Peroral Cholangioscopy ◽  
Impression Accuracy ◽  
Tertiary Center

Objectives: Peroral cholangioscopy (POC) has shown to be a useful diagnostic procedure in the evaluation of biliary strictures; however, data regarding its role on preoperative staging are scarce. The aim of this study was to evaluate POC role in the diagnosis and preoperative intraductal staging of perihilar cholangiocarcinoma (CCA). Methods: Retrospective study that included all patients who underwent POC with SpyGlassTM Direct Visualization System for the diagnosis of biliary strictures or for preoperative evaluation of extrahepatic biliary tumors, between 2015 and 2019, in a single tertiary center. Results: Forty-three patients were included, 63% male with a median age of 62 years. Thirty-eight (88.3%) underwent POC due to indeterminate biliary strictures, 3 (7%) due to bile duct filling defect, and 2 (4.7%) for intraductal staging of perihilar CCA. In the follow-up, a final diagnosis of malignancy was established in 56% of the patients. Visual impression accuracy with SpyGlass was 95.1% (with 100% sensitivity and 89.5% specificity). SpyBite biopsies accuracy was 80.5% (63.6% sensitivity and 100% specificity). In the 19 patients with a final perihilar CCA diagnosis, intraductal evaluation with SpyGlass altered anatomic classification (Bismuth-Corlette) defined by previous imagiologic findings in 8 (42.1%) patients. Alteration in anatomic classification changed therapeutic approach in 4 (21%). Conclusions: POC use for evaluating intraductal spread in potentially resectable perihilar CCA can detect more extensive and change surgical management. In the future, preoperative staging of perihilar CCA with POC combined with imagiologic evaluation of vascular extension of the lesions may optimize surgical results.

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