Universität zu Köln

Buerger, Martin, Besser, Antje, Petersen, Iver, Stallmach, Andreas and Schmidt, Carsten (2020). Ethanol-based fixation is superior to conventional brush cytology in the evaluation of indeterminate biliary strictures by endoscopic retrograde cholangiography. Medicine (Baltimore), 99 (5). PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1536-5964

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Abstract

The aim of this study was to compare the diagnostic yield of conventional cytology (CC) with ethanol-based fixation, a cytological analysis using an ethanol based fixative system including a cell block procedure (EBF) to evaluate indeterminate biliary strictures (IBStr). We also compared additionally taken fluorescence-guided forceps biopsies (FB) with EBF concerning a potential additive diagnostic benefit.Early detection and accurate diagnosis are crucial for patients with suspected carcinoma within the biliary tree to preserve curative treatment options but diagnostics and patient care in the evaluation of IBStr are still challenging. ERC-guided brush cytology is the gold standard of nonsurgical evaluation of IBStr. However, accuracy is generally low. New specimen processing's are needed to higher the diagnostic yield in the evaluation of IBStr.We performed a retrospective evaluation in 404 patients referred for further diagnosis of IBStr. Gold standard was defined as surgically obtained histology or patient follow-up of at least 1 year to diagnose or exclude malignancy.Three hundred thirty-four patients were included into the final analysis. One hundred seventy-two strictures were malignant, 162 strictures benign. One hundred seventeen specimens were evaluated by CC, 217 processed by EBF. EBF performed significantly better in terms of sensitivity (24.6% vs 60%, P<.001) and accuracy (59.0% vs 75.1%, P=.006). Fifty-eight FB were additionally taken and showed a numerically improved sensitivity compared to EBF alone (80% vs 62.9%, P=.19).EBF is a simple and inexpensive technique that substantially improved sensitivity and accuracy in the evaluation of IBStr. FB specimen did not significantly improve diagnostic yield.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Buerger, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Besser, Antje UNSPECIFIED UNSPECIFIED UNSPECIFIED Petersen, Iver UNSPECIFIED UNSPECIFIED UNSPECIFIED Stallmach, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-351006
DOI:	10.1097/MD.0000000000018920
Journal or Publication Title:	Medicine (Baltimore)
Volume:	99
Number:	5
Date:	2020
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1536-5964
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PANCREATIC-CANCER; DIAGNOSTIC YIELD; ERCP; ASPIRATION; EUS; CHOLANGIOPANCREATOGRAPHY; MALIGNANCIES; BIOPSY Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/35100