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DOI: 10.1055/s-0038-1637154
INTRADUCTAL ULTRASOUND FOR SECOND-LEVEL EVALUATION OF BILIARY AND AMPULLARY STENOSES: EXPERIENCE FROM THE TURIN CENTER
Publication History
Publication Date:
27 March 2018 (online)
Aims:
Standard diagnostic approach for biliary strictures like MRCP or CT often is not enough to evaluate biliary strictures and needs to be completed with second level techniques such as EUS and/or IDUS. Aim of this study is to assess sensitivity and specificity of IDUS and brushing in differentiating between malignant and benign lesions compared with standard techniques.
Methods:
We retrospectively analyzed data of patients who underwent IDUS +/- brushing/papillary biopsies for suspected biliary stenosis with a previous non conclusive first level technique, in our Centre from March 2003 to February 2017
Results:
We included 86 patients (mean age 69 years; 41 F – 45 M). Previous imaging findings were: suspected flogistic biliary stricture in 33/86 (38,3%), suspected neoplastic stricture in 15/86 (17,4%), undefined stenosis 14/86 (16,2%), papillary ampulloma in 10/86 (8,6%), lithiasis in 8/86 (9,3%), intraluminal mass in 1/86, while in 5/86 (5,8%) aspecific findings.
IDUS described a flogistic stenosis in 40/86 (46,5%), a neoplastic stricture in 21/86 (24,4%), concomitant neoplastic and flogistic stenosis in 5/86 (5,8%), papillitis in 4/86 (4,6%), duct malformations in 4/86, biliary papillomatosis in 2/86. Two patients had no abnormalities at IDUS.
57/86 patients underwent biliary brushing, 12 with positive findings for dysplastic or neoplastic cells. In 19/86 patients were made papillary biopsies with an histological diagnosis of neoplasia in 5 and of ampulloma in 1.
Ssensitivity, specificity and accuracy of IDUS were 82%, 95% and 93% respectively.
We re-evaluated patients after a mean time of 72 months: in 24, flogistic stenosis were treated with biliary stent; 18 had surgery for biliary/pancreatic malignancy and 17 for flogistic stenosis, 4 underwent supportive cares. 18 didn't need further treatments, 6 were lost at follow-up.
Conclusions:
IDUS +/- brushing or papillary biopsies have a greater sensitivity and specificity in differentiating benign from malignant biliary or ampullary stenoses, compared to standard imaging techniques.