Histological assessment of new cholangioscopy-guided forceps in ERCP biliary stricture sampling: a blinded comparative study
Background and study aims Obtaining quality tissue during ERCP biliary stricture sampling is of paramount importance for a timely diagnosis. While single-operator cholangioscopy (SOC)-guided biopsies have been suggested to be the superior biliary tissue acquisition modality given direct tissue visua...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2022-09-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1897-4686 |
| _version_ | 1811268170510499840 |
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| author | Eric J. Vargas Yaohong Wang Zongming Eric Chen Rami Abusaleh Andrew C. Storm John A. Martin Ryan J. Law Barham K. Abu Dayyeh Michael J. Levy Bret Petersen Vinay Chandrasekhara |
| author_facet | Eric J. Vargas Yaohong Wang Zongming Eric Chen Rami Abusaleh Andrew C. Storm John A. Martin Ryan J. Law Barham K. Abu Dayyeh Michael J. Levy Bret Petersen Vinay Chandrasekhara |
| author_sort | Eric J. Vargas |
| collection | DOAJ |
| description | Background and study aims Obtaining quality tissue during ERCP biliary stricture sampling is of paramount importance for a timely diagnosis. While single-operator cholangioscopy (SOC)-guided biopsies have been suggested to be the superior biliary tissue acquisition modality given direct tissue visualization, less is known about the specimen histological quality. We aimed to analyze the specimen quality of SOC biopsies and compare the new generation forceps with prior “legacy” forceps.
Patients and methods Patients who underwent SOC from January 2017-August 2021 for biliary sampling were reviewed. In February 2020, the SOC-guided biopsy forceps were changed from legacy SpyBite to the SpyBite Max forceps (max). Specimens were assessed by blinded pathologists for crush artifact (none, mild, or severe) and gross size (greatest dimension in mm). Crush artifact and gross size were compared between the two groups. The diagnostic performance characteristics for cholangiocarcinoma (CCA), were assessed in an exploratory fashion.
Results Eighty-one patients (max = 27, legacy = 54) with similar baseline characteristics were included in this study. On blinded pathological assessment, 58 % had crush artifact, without significant differences between the two groups (Max 63 % vs. Legacy 56 %; P = 0.64). A similar mean specimen size was found (max 3 mm vs. legacy 3.2 mm; P = 0.24). The overall prevalence of CCA was 40 %. The sensitivity, specificity, positive predictive value, and negative predictive value of the entire cohort using a combination of cytology, fluorescence in situ hybridization, and SOC-guided biopsies were 78.1 %, 91.8 %, 86.2 %, and 86.5 %, respectively. No difference between legacy or max groups was found.
Conclusions A high rate of crush artifact was found in SOC-guided biopsy specimens. Further investigation regarding proper biopsy technique and handling is necessary to increase the diagnostic yield with SOC-guided biopsies. |
| first_indexed | 2024-04-12T21:17:02Z |
| format | Article |
| id | doaj.art-505c1bf0d95b4cb6bbfb3ce0ce37e289 |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-04-12T21:17:02Z |
| publishDate | 2022-09-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-505c1bf0d95b4cb6bbfb3ce0ce37e2892022-12-22T03:16:24ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362022-09-011009E1233E123710.1055/a-1897-4686Histological assessment of new cholangioscopy-guided forceps in ERCP biliary stricture sampling: a blinded comparative studyEric J. Vargas0Yaohong Wang1Zongming Eric Chen2Rami Abusaleh3Andrew C. Storm4John A. Martin5Ryan J. Law6Barham K. Abu Dayyeh7Michael J. Levy8Bret Petersen9Vinay Chandrasekhara10Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United StatesVanderbilt University School of Medicine, Pathology, Microbiology and Immunology, Nashville, Tennessee, United StatesDepartment of Pathology, Mayo Clinic Rochester, Rochester, Minnesota, United StatesDepartment of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United StatesDepartment of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United StatesDepartment of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United StatesDepartment of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United StatesDepartment of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United StatesDepartment of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United StatesDepartment of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United StatesDepartment of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota, United StatesBackground and study aims Obtaining quality tissue during ERCP biliary stricture sampling is of paramount importance for a timely diagnosis. While single-operator cholangioscopy (SOC)-guided biopsies have been suggested to be the superior biliary tissue acquisition modality given direct tissue visualization, less is known about the specimen histological quality. We aimed to analyze the specimen quality of SOC biopsies and compare the new generation forceps with prior “legacy” forceps. Patients and methods Patients who underwent SOC from January 2017-August 2021 for biliary sampling were reviewed. In February 2020, the SOC-guided biopsy forceps were changed from legacy SpyBite to the SpyBite Max forceps (max). Specimens were assessed by blinded pathologists for crush artifact (none, mild, or severe) and gross size (greatest dimension in mm). Crush artifact and gross size were compared between the two groups. The diagnostic performance characteristics for cholangiocarcinoma (CCA), were assessed in an exploratory fashion. Results Eighty-one patients (max = 27, legacy = 54) with similar baseline characteristics were included in this study. On blinded pathological assessment, 58 % had crush artifact, without significant differences between the two groups (Max 63 % vs. Legacy 56 %; P = 0.64). A similar mean specimen size was found (max 3 mm vs. legacy 3.2 mm; P = 0.24). The overall prevalence of CCA was 40 %. The sensitivity, specificity, positive predictive value, and negative predictive value of the entire cohort using a combination of cytology, fluorescence in situ hybridization, and SOC-guided biopsies were 78.1 %, 91.8 %, 86.2 %, and 86.5 %, respectively. No difference between legacy or max groups was found. Conclusions A high rate of crush artifact was found in SOC-guided biopsy specimens. Further investigation regarding proper biopsy technique and handling is necessary to increase the diagnostic yield with SOC-guided biopsies.http://www.thieme-connect.de/DOI/DOI?10.1055/a-1897-4686 |
| spellingShingle | Eric J. Vargas Yaohong Wang Zongming Eric Chen Rami Abusaleh Andrew C. Storm John A. Martin Ryan J. Law Barham K. Abu Dayyeh Michael J. Levy Bret Petersen Vinay Chandrasekhara Histological assessment of new cholangioscopy-guided forceps in ERCP biliary stricture sampling: a blinded comparative study Endoscopy International Open |
| title | Histological assessment of new cholangioscopy-guided forceps in ERCP biliary stricture sampling: a blinded comparative study |
| title_full | Histological assessment of new cholangioscopy-guided forceps in ERCP biliary stricture sampling: a blinded comparative study |
| title_fullStr | Histological assessment of new cholangioscopy-guided forceps in ERCP biliary stricture sampling: a blinded comparative study |
| title_full_unstemmed | Histological assessment of new cholangioscopy-guided forceps in ERCP biliary stricture sampling: a blinded comparative study |
| title_short | Histological assessment of new cholangioscopy-guided forceps in ERCP biliary stricture sampling: a blinded comparative study |
| title_sort | histological assessment of new cholangioscopy guided forceps in ercp biliary stricture sampling a blinded comparative study |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-1897-4686 |
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