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Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions.

Publication ,  Journal Article
Byrne, MF; Gerke, H; Mitchell, RM; Stiffler, HL; McGrath, K; Branch, MS; Baillie, J; Jowell, PS
Published in: Endoscopy
August 2004

BACKGROUND AND STUDY AIMS: It is still difficult to differentiate reliably between benign and malignant biliary tract lesions. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has added to the diagnostic power of EUS for other gastrointestinal tumors. A retrospective analysis of experience with FNA sampling of bile duct lesions was therefore carried out. PATIENTS AND METHODS: All EUS-FNA procedures for bile duct masses or strictures were analyzed at our tertiary referral center from May 2000 through October 2002. Data for EUS findings, the results of EUS-FNA, and tissue sampling at surgery were included. EUS-FNA procedures were carried out using a 22-gauge needle. An experienced cytopathologist was present during FNA in all but three cases. Clinical follow-up details were recorded when available for patients in whom a suitable diagnostic gold standard was not available for comparison. RESULTS: A total of 35 patients underwent EUS-FNA of bile duct lesions during the study period. There were no complications. Data for EUS-FNA of bile duct masses or strictures and tissue obtained at surgery were available for 23 patients. If positive cytology at surgical pathology is taken as the gold standard, EUS-FNA has a diagnostic yield for cancer of 100 % (if atypia/inconclusive findings in the FNA sample are regarded as benign). Eleven patients had a definite malignancy on surgical pathology. Of these 11 patients, five had a finding of malignancy on EUS-FNA, giving a sensitivity of 45 % (if FNA cytology reported as atypia/inconclusive is regarded as benign). Twelve patients had findings of no malignancy from tissue obtained at surgery. Of these 12 patients, nine had benign pathology and three had atypia/inconclusive findings in the EUS-FNA sample (specificity of 100 % if atypia/inconclusive findings are considered benign). A further 12 patients did not have surgical specimens for comparison with EUS-FNA results. Four patients had definite findings of malignancy on EUS-FNA alone, and one patient had FNA findings suspicious for malignancy. Seven patients had negative or equivocal EUS-FNA results. These 12 patients are described but excluded from further analysis, as a gold standard was not available for comparison. However, clinical follow-up data were available for eight of these 12 patients, and in each case the follow-up findings were compatible with previous benign or malignant EUS-FNA findings. CONCLUSIONS: The practice of EUS-FNA has improved the diagnostic yield of EUS. These results suggest that it is a safe and useful procedure for investigating biliary masses or strictures that have hitherto caused considerable diagnostic confusion, especially in patients with negative brush cytology findings. The possibility of false-negative findings remains, but core biopsy needles may improve the situation. The results of further studies are awaited.

Duke Scholars

Published In

Endoscopy

DOI

ISSN

0013-726X

Publication Date

August 2004

Volume

36

Issue

8

Start / End Page

715 / 719

Location

Germany

Related Subject Headings

  • Sensitivity and Specificity
  • Retrospective Studies
  • Male
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Endosonography
  • Biopsy, Fine-Needle
  • Biliary Tract Diseases
  • Bile Duct Neoplasms
 

Citation

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ICMJE
MLA
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Byrne, M. F., Gerke, H., Mitchell, R. M., Stiffler, H. L., McGrath, K., Branch, M. S., … Jowell, P. S. (2004). Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions. Endoscopy, 36(8), 715–719. https://doi.org/10.1055/s-2004-825657
Byrne, M. F., H. Gerke, R. M. Mitchell, H. L. Stiffler, K. McGrath, M. S. Branch, J. Baillie, and P. S. Jowell. “Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions.Endoscopy 36, no. 8 (August 2004): 715–19. https://doi.org/10.1055/s-2004-825657.
Byrne MF, Gerke H, Mitchell RM, Stiffler HL, McGrath K, Branch MS, et al. Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions. Endoscopy. 2004 Aug;36(8):715–9.
Byrne, M. F., et al. “Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions.Endoscopy, vol. 36, no. 8, Aug. 2004, pp. 715–19. Pubmed, doi:10.1055/s-2004-825657.
Byrne MF, Gerke H, Mitchell RM, Stiffler HL, McGrath K, Branch MS, Baillie J, Jowell PS. Yield of endoscopic ultrasound-guided fine-needle aspiration of bile duct lesions. Endoscopy. 2004 Aug;36(8):715–719.
Journal cover image

Published In

Endoscopy

DOI

ISSN

0013-726X

Publication Date

August 2004

Volume

36

Issue

8

Start / End Page

715 / 719

Location

Germany

Related Subject Headings

  • Sensitivity and Specificity
  • Retrospective Studies
  • Male
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Endosonography
  • Biopsy, Fine-Needle
  • Biliary Tract Diseases
  • Bile Duct Neoplasms