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Endoscopic ultrasound‐guided FNA biopsy of bile duct and gallbladder: analysis of 53 cases
Author(s) -
Meara R. S.,
Jhala D.,
Eloubeidi M. A.,
Eltoum I.,
Chhieng D. C.,
Crowe D. R.,
Varadarajulu S.,
Jhala N.
Publication year - 2006
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/j.1365-2303.2006.00319.x
Subject(s) - medicine , gallbladder , radiology , endoscopic ultrasound , bile duct , biopsy , carcinoma , fine needle aspiration , sampling (signal processing) , biliary tract , surgical pathology , gastroenterology , filter (signal processing) , computer science , computer vision
Objective: Endoscopic retrograde cholangiopancreaticography (ERCP)‐guided brushing has been the standard of practice for surveillance and detection of carcinoma in the biliary tree. Few studies have evaluated the role of endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) in diagnosing clinically suspected cholangiocarcinoma. The role of this method in diagnosing clinically suspected gallbladder malignancies has not been extensively evaluated in the USA. This study investigates the role of EUS‐FNA in the diagnosis of clinically suspected biliary tree and gallbladder malignancies in a large patient series. Methods: EUS‐FNAs were obtained from 46 bile duct and seven gallbladder lesions. On‐site rapid interpretation was provided using air‐dried Diff Quik stained smears. In addition, alcohol fixed Papanicoloau stained smears and Thin Prep preparations (Cytye Corp., Marlborough, MA, USA) were evaluated before providing a final cytological diagnosis. Tissue biopsies and/or clinical follow‐up were used as the standards to determine operating characteristics for EUS‐FNA. Results: The mean ages for bile duct and gallbladder lesions were 66 years (range: 37–84 years), and 69 years (range 49–86 years), respectively. All cases diagnosed as suspicious/malignant on preliminary evaluation were confirmed on final cytological interpretation (27/27). The operating characteristics show that EUS‐FNA is highly specific (100%) with sensitivity rates of 87% and 80% from clinically suspected malignancies of biliary tract and gallbladder, respectively. Sampling error in three cases and associated acute inflammation in two cases resulted in false‐negative diagnoses. Conclusions: EUS‐FNA of biliary tree and gallbladder carcinoma is highly specific and should be considered for evaluation of clinically suspicious lesions. Marked inflammation may result in false‐negative diagnoses.