Year 2025 / Volume 117 / Number 4
Original
Acceptable number of cholangioscopy-guided biopsies for diagnosing perihilar cholangiocarcinoma

198-204

DOI: 10.17235/reed.2024.10719/2024

Juan Octavio Alonso Lárraga, José Miguel Jiménez-Gutiérrez, Marcos Meneses-Mayo, Angélica Hernández-Guerrero, Mónica Lizzette Serrano-Arévalo, Lidia Faridi Villegas-González,

Abstract
Introduction: diagnosing perihilar cholangiocarcinoma can be challenging. Previous studies suggest that the sensitivity of taking three cholangioscopy-guided biopsies is approximately 70 %. We hypothesized that obtaining four or more biopsies might improve the sensitivity for diagnosing perihilar cholangiocarcinoma. Objective: to determine the acceptable number of cholangioscopy-guided biopsies to improve sensitivity for diagnosing perihilar cholangiocarcinoma. Methods: this retrospective study analyzed clinical records of adults with perihilar stenosis who underwent cholangioscopy-guided biopsies. Patients with gallbladder cancer or metastatic bile duct obstruction were excluded. Data were grouped based on the number of biopsies taken: group A (one to three biopsies), group B (four to six biopsies), and group C (seven to ten biopsies). Results from each group were compared against a composite standard, including clinical follow-up and/or biopsies performed by alternative methods. Results: the group that underwent 4-6 biopsies had a sensitivity of 77.4 %, while the group with 7-10 biopsies had a sensitivity of 70.8 %. The group with 1-3 biopsies had a sensitivity of 34.5 %. Statistically significant differences were observed between the groups, with comparisons showing improved sensitivity in the 4-6 biopsy group versus the 1-3 biopsy group (χ² = 14.42, p = 0.0001), and the 7-10 biopsy group versus the 1-3 biopsy group (χ² = 6.56, p = 0.010). Conclusions: performing four to six cholangioscopy-guided biopsies significantly improves sensitivity for diagnosing perihilar cholangiocarcinoma compared to one to three biopsies. Further studies are needed to validate these findings.
Lay Summary
Diagnosing cancer in the bile ducts can be difficult. When doctors take biopsies (small samples of tissue to test for cance) they only manage to confirm a diagnosis in about 7 out of 10 patients. The number of biopsies taken may affect whether the disease is identified. We thought that increasing the number of biopsies might improve the chances of correctly finding cancer in the bile ducts. Our study aimed to find the ideal number of biopsies needed to detect bile duct cancer with confidence. To do this, we looked at medical records of adult patients who had bile duct biopsies taken through a procedure called cholangioscopy. We divided the information into three groups based on how many biopsies were taken: A) 1 to 3 biopsies, B) 4 to 6 biopsies, and C) 7 to 10 biopsies. The analysis showed that when 4 to 6 biopsies were taken, doctors could diagnose bile duct cancer in 77.4% of cases. When 7 or more biopsies were taken, cancer was identified in 70.8% of patients. Lastly, when only 1 to 3 biopsies were taken, doctors successfully diagnosed cancer only 34.5% of the time.
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2. Khan SA, Tavolari S, Brandi G. Cholangiocarcinoma: Epidemiology and risk factors. Liver Int. May 2019;39(S1):19-31.
3. Razumilava N, Gores GJ. Classification, Diagnosis, and Management of Cholangiocarcinoma. Clin Gastroenterol Hepatol. January 2013;11(1):13-21.e1.
4. De Oliveira ML, Cunningham SC, Cameron JL, et al. Cholangiocarcinoma: Thirty-one-year experience with 564 patients at a single institution. Ann Surg. May 2007;245(5):755-62.
5. Dorrell R, Pawa S, Zhou Y, et al. The diagnostic dilemma of malignant biliary strictures. Diagnostics. May 2020;10(5):337.
6. Nakai Y, Isayama H, Wang H, et al. International consensus statements for endoscopic management of distal biliary stricture. J Gastroenterol Hepatol. June 2020;35(6):967-79.
7. Fujii-Lau LL, Thosani NC, Al-Haddad M, et al. ASGE guideline on the role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: Summary and recommendations. Gastrointest Endosc. 2023 Nov;98(5):685-693.
8. Razumilava N, Gores GJ. Cholangiocarcinoma. Lancet. June 2014;383(9935):2168-79.
9. Jang S, Stevens T, Kou L, et al. Efficacy of digital single-operator cholangioscopy and factors affecting its accuracy in the evaluation of indeterminate biliary stricture. Gastrointest Endosc. February 2020;91(2):385-93.e1.
10. Angsuwatcharakon P, Kulpatcharapong S, Moon JH, et al. Consensus guidelines on the role of cholangioscopy to diagnose indeterminate biliary stricture. HPB. January 2022;24(1):17-29.
11. Bang JY, Navaneethan U, Hasan M, et al. Optimizing outcomes of single-operator cholangioscopy–guided biopsies based on a randomized trial. Clin Gastroenterol Hepatol. February 2020;18(2):441-48.e1.
12. Lenze F, Bokemeyer A, Gross D, et al. Diagnostic accuracy and therapeutic efficacy of digital single-operator cholangioscopy. United European Gastroenterol J. July 2018;6(6):902-9.
13. de Vries AB, van der Heide F, ter Steege RWF, et al. Limited diagnostic accuracy and clinical impact of single-operator peroral cholangioscopy for indeterminate biliary strictures. Endoscopy. February 2020;52(2):107-14.
14. Hartman DJ, Slivka A, Giusto DA, et al. Tissue yield and diagnostic efficacy of fluoroscopic and cholangioscopic techniques to assess indeterminate biliary strictures. Clin Gastroenterol Hepatol. September 2012;10(9):1042-6.
15. Navaneethan U, Hasan MK, Lourdusamy V, et al. Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: A systematic review. Gastrointest Endosc. October 2015;82(4):608-14.e2.
16. Tamada K, Kurihara K, Tomiyama T, et al. How many biopsies should be performed during percutaneous transhepatic cholangioscopy to diagnose biliary tract cancer? Gastrointest Endosc. November 1999;50(5):653-8.
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Alonso Lárraga J, Jiménez-Gutiérrez J, Meneses-Mayo M, Hernández-Guerrero A, Serrano-Arévalo M, Villegas-González L, et all. Acceptable number of cholangioscopy-guided biopsies for diagnosing perihilar cholangiocarcinoma. 10719/2024


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Publication history

Received: 11/08/2024

Accepted: 15/10/2024

Online First: 19/11/2024

Published: 03/04/2025

Article revision time: 42 days

Article Online First time: 100 days

Article editing time: 235 days


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