EUS guided fine needle aspiration is useful in diagnostic evaluation of indeterminate proximal biliary strictures

作     者：Naveen B. Krishna Pavan Tummala Jennifer L. Labundy Banke Agarwal 

作者机构：Division of Gastroenterology and Hepatology Saint Louis University School of Medicine Saint Louis USA 

出 版 物：《Open Journal of Gastroenterology》 (肠胃病学期刊（英文）)

年 卷 期：2012年第2卷第2期

页      面：33-39页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：EUS-FNA Cholangiocarcinoma Proximal Biliary Strictures 

摘      要：Background and Aim: Determination of the etiology of proximal biliary strictures (PBS) still remains a challenge. Even though EUS-FNA is potentially useful, its role in diagnostic evaluation of PBS is still not established due to a lack of sufficient data. We sought to determine the performance characteristics of EUS-FNA in patients with obstructive jaundice (ObJ) and PBS. Patients and Methods: This is a retrospective analysis and included patients with ObJ and PBS with non-diagnostic brush cytology, who underwent EUS-FNA in our university based practice from March 2002 to February 2009. We evaluated the final diagnoses in study patients and the performance characteristics of EUS-FNA for identifying malignant PBS. Final diagnosis was based on surgical pathology or clinical follow-up of at least 12 months. Results: The study included 28 patients (17 male, 11 female) with mean age of 62.4 ± 14.9 years. The strictures ranged from 10 - 70 mm in length. CT scan identified a hilar mass in 9 patients. EUS-FNA identified malignancy in 12 patients. 18 patients were finally diagnosed to have a malignant stricture and 10 patients had a benign stricture. There were 6 false negative diagnoses. The accuracy of EUS-FNA for diagnosis of cholangiocarcinoma was 78.6%, with 66.6% sensitivity, 100% specificity, 62.5% NPV and 100% PPV. Conclusions: EUS-FNA can diagnose malignancy in 66.6% of jaundiced patients with PBS and non-diagnostic brush cytology and may have a role in their further diagnostic evaluation.