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DOI: 10.1055/s-0040-1704989
EUS-FNA AND ERCP IN THE PRESURGICAL DIAGNOSIS OF MALIGNANT BILIARY STENOSIS: PRELIMINARY RESULTS OF A COMPARATIVE STUDY
Publication History
Publication Date:
23 April 2020 (online)
Aims Endoscopic ultrasonography (EUS) with fine needle aspiration (EUS-FNA) has been proposed in addition to cholangiopancreatography (ERCP) for tissue sampling in the diagnosis of a malignant from non-malignant biliary stenosis. Aim of the study was to evaluate the diagnostic power of EUS-FNA alone and in combination with ERCP in biliary stenosis.
Methods 134 patients, hospitalized for jaundice, underwent EUS plus CT scan or MRI. Tissue sampling by EUS-FNA and/or brushing-forceps biopsy during ERCP was performed if a cholangiocarcinoma (CCA) was suspected. Final diagnosis was defined based on histopathology of surgical specimen or outcome at follow-up.
Results 56 patients (42%) underwent EUS plus MRI, 42 (32%) EUS plus CT scan, and 36 (26%) EUS plus CT scan plus MRI. ERCP was performed in 65 patients, in 16/65 EUS-FNA and ERCP were carried out in a same session. A biliary stenosis was diagnosed in 19 patients, which was a CCA in 13 (10%) and a benign condition in 6. The remaining 115 patients had a non-stenosing benign condition. EUS findings were diagnostic in 11/13 patients with CCA. Sensitivity, specificity and diagnostic accuracy in CCA were: 85%, 97% and 95% for EUS-FNA alone; 82%, 100% and 88% for EUS-FNA plus ERCP forceps biopsy and brushing.
Conclusions EUS shows a high diagnostic accuracy in diagnosing malignant and non-malignant biliary stenosis. The possibility to perform EUS-FNA for tissue acquisition in a same session of ERCP may increase the diagnostic accuracy and reduce the time for diagnosis.
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