Peroral Cholangioscopy-Guided Forceps Mapping Biopsy for Evaluation of the Lateral Extension of Biliary Tract Cancer

Background: Peroral cholangioscopy (POCS)-guided forceps mapping biopsy (FMB) is a method for the accurate preoperative identification of the extent of the disease of biliary tract cancer (BTC). However, the diagnostic value of POCS-FMB is still uncertain. Objectives: We evaluated the diagnostic utility of POCS-FMB for the identification of lateral extension—superficial intraductal spread longitudinally and continuously from the main lesion—of BTC. Methods: In the retrospective study, patients who received POCS-FMB and surgery for curative resection of BTC between September 2016 and August 2019 at our medical institution were enrolled. The diagnostic accuracy of POCS-FMB for the identification of lateral extension of BTC was evaluated. Furthermore, we also evaluated the factors affecting the diagnostic accuracy of POCS-FMB. Results: A total of 23 patients with BTC were enrolled, and 24 procedures of POCS-FMB from 96 sites of biliary tracts were performed. The sensitivity, specificity, and accuracy of POCS-FMB were 53.8%, 63.9%, and 63.1%, respectively. In the multivariate logistic regression analyses, the biopsy from the bifurcation of biliary tracts was a significant factor affecting the diagnostic accuracy of POCS-FMB (odds ratio 3.538, 95%; confidence interval 1.151–10.875, p = 0.027). Conclusions: The diagnostic accuracy of POCS-FMB for the identification of lateral extension of BTC was insufficient. The biopsy from the bifurcation of biliary tracts was a positive factor affecting the diagnostic accuracy of POCS-FMB.

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Sufficient Tissue Acquisition Rate of Peroral Cholangioscopy-guided Forceps Biopsy

10.21203/rs.2.15793/v1 ◽

2019 ◽

Author(s):

Takumi Onoyama ◽

Yohei Takeda ◽

Soichiro Kawata ◽

Hiroki Kurumi ◽

Hiroki Koda ◽

...

Keyword(s):

Bile Duct ◽

Biliary Tract ◽

Biliary Disease ◽

Acquisition Rate ◽

Factors Affecting ◽

Forceps Biopsy ◽

Tract Cancer ◽

Peroral Cholangioscopy ◽

Tissue Acquisition ◽

Mapping Biopsy

Abstract Background: Peroral cholangioscopy (POCS)-guided forceps biopsy is a method for diagnosing indeterminate biliary strictures and for the preoperative identification of the exact perihilar and distal margins of biliary tract cancer (BTC). However, POCS-guided forceps biopsy may result in an insufficient amount of specimen at times. Aims: We evaluated the sufficient tissue acquisition rate and the factors affecting the sufficient tissue acquisition of POCS-guided forceps biopsy for the biliary tract. Methods: Patients who underwent POCS-guided forceps biopsy for biliary disease between September 2016 and October 2018 at our hospital were enrolled retrospectively. We evaluated the sufficient tissue acquisition rate of POCS-guided forceps biopsy for the biliary lesion and that for non-stenotic bile duct. In addition, the factors affecting the sufficient tissue acquisition rate of POCS-guided forceps biopsy were evaluated. Results and Conclusions : We enrolled 47 patients with the biliary disease and performed POCS-guided forceps biopsy for biliary lesion and POCS-guided forceps mapping biopsy for non-stenotic bile duct in 40 and 36 patients, respectively. The sufficient tissue acquisition rates of POCS-guided forceps biopsy for biliary lesions and that for non-stenotic bile duct were 86.4%, and 68.9%, respectively. In the multivariate logistic regression analyses, age and previous biliary stenting before POCS were factors affecting the sufficient tissue acquisition rate of POCS-guided forceps biopsy for the biliary lesion. For non-stenotic bile duct, the location of the biliary lesion, endoscopic sphincterotomy, and procedure time of POCS were factors affecting the sufficient tissue acquisition rate of POCS-guided forceps mapping biopsy.

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Prognostic factor analysis of second-line chemotherapy in advanced biliary tract cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14688 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14688-e14688 ◽

Cited By ~ 4

Author(s):

Sang-Cheol Lee ◽

Kyoungha Kim ◽

Hanjo Kim ◽

Hyun Jung Kim ◽

Se Hyung Kim ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Biliary Tract ◽

Biliary Tract Cancer ◽

Salvage Chemotherapy ◽

Second Line ◽

First Line ◽

Factors Affecting ◽

Tract Cancer ◽

Line Chemotherapy

e14688 Background: There is no evidence that second-line chemotherapy in advanced biliary tract cancer (BTC) will result in substantial prolongation of survival. The purpose of this study was to evaluate prognostic factors for the survival of patients with advanced biliary tract cancer who was refractory BTC for first-line chemotherapy. Methods: We reviewed 89 patients retrospecitively with advanced biliary tract cancer who had enrolled in two clinical trials at three branches of Soonchunhyang university hospital. They received palliative chemotherapy with 2 regimens (biweekly GEMOX and modified FOLFOX-6). GEMOX is consist of gemcitabine 1,000 mg/m2 intravenously on day 1 and oxaliplatin 85 mg/m2 intravenously on day 2 every 2 weeks and mFOLFOX-6 is that oxaliplatin 85mg/m2 and folinic acid 400 mg/m2 on day 1 follwed by a 5-FU bolus 400 mg/m2 and 46-h infusion 2400 mg/m2 every 2 weeks. To evaluate the clinicopathologic factors that affected overall survival, univariate and multivariate analyses were performed on the baseline factors. Results: 89 patients were enrolled from Sep 2006 to Aug 2010. Medain age was 62.14 years (range 35-81). Univariate analysis revealed 4 prognostic factors affecting overall survival after first-line chemotherapy. Performance status of 0-1 vs >2 (p=0.014), salvage chemotherapy (p=0.021), locoregional disease vs disseminated disease (p=0.046) and responder of first-line chemotherapy (p=0.025) was revealed. Multivariate analysis found 2 prognostic factors affecting overall survival. They were salvage chemotherapy and initial responder. Conclusions: This results suggest that 2nd-line chemotherapy is needed for patients with good performance and responder of initial chemotherapy.

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