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Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma

World Journal of Gastroenterology 2008年第7期14卷 1097-1101页

作者： Andreas Weber Claus von Weyhern Falko Fend Jochen Schneider Bruno Neu Alexander Meining Hans Weidenbach Roland M Schmid Christian Prinz Department of Internal Medicine Ⅱ Technical University of Munich Munich 81675 Germany Department of Pathology Technical University of Munich Munich 81675 Germany

AIM: To evaluate the sensitivity of brush cytology and forceps biopsy in a homogeneous patient group with hilar ***: Brush cytology and forceps biopsy were routinely performed in patients with suspected malignant biliary strictures. Fifty-eight consecutive patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) including forceps biopsy and brush cytology in patients with hilar cholangiocarcinoma between ***: Positive results for malignancy were obtained in 24/58 patients (41.4%) by brush cytology and in 31/58 patients (53.4%) by forceps biopsy. The combination of both techniques brush cytology and forceps biopsy resulted only in a minor increase in diagnostic sensitivity to 60.3% (35/58 patients). In 20/58 patients (34.5%), diagnosis were obtained by both positive cytology and positive histology, in 11/58 (19%) by positive histology (negative cytology) and only 4/58 patients (6.9%) were confirmed by positive cytology (negative histology).CONCLUSION: Brush cytology and forceps biopsy have only limited sensitivity for the diagnosis of malignant hilar tumors. In our eyes, additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings.

关键词： Brush cytology forceps biopsy Cholangiocarcinoma Klatskin tumor Endoscopy Diagnostic approaches

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Diagnostic approaches for cholangiocarcinoma

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World Journal of Gastroenterology 2008年第26期14卷 4131-4136页

作者： Andreas Weber Roland M Schmid Christian Prinz Department of Internal Medicine Ⅱ Technical University of MunichMunich 81675Germany

Cholangiocarcinomas arise from the epithelial cells of the bile ducts and are associated with poor prognosis. Despite new diagnostic approaches, the definite diagnosis of this malignancy continues to be challenging. Cholangiocarcinomas often grow longitudinally along the bile duct rather than in a radial direction. Thus, large tumor masses are frequently absent and imaging techniques, including ultrasound, CT, and MRI have only limited sensitivity. Tissue collection during endoscopic (ERCP) and/or percutaneous transhepatic (PTC) procedures are usually used to confirm a definitive diagnosis of cholangiocarcinoma. However, forceps biopsy and brush cytology provide positive results for malignancy in about only 50% of patients. Percutaneous and peroral cholangioscopy using fiber-optic techniques were therefore developed for direct visualization of the biliary tree, yielding additional information about endoscopic appearance and tumor extension, as well as a guided biopsy acquistion. Finally, endoscopic ultrasonography (EUS) complements endoscopic and percutaneous approaches and may provide a tissue diagnosis of tumors in the biliary region through fine-needle aspiration. In the future, new techniques allowing for early detection, including molecular markers, should be developed to improve the diagnostic sensitivity in this increasing tumor entity.

关键词： Diagnosis Brush cytology forceps biopsy Cholangiocarcinoma

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