scholarly journals Role of Peroral Cholangioscopy for Diagnosis and Staging of Biliary Tumors

2020 ◽  
Vol 38 (5) ◽  
pp. 431-440 ◽  
Author(s):  
Pedro Pereira ◽  
Sancha Santos ◽  
Rui Morais ◽  
Rui Gaspar ◽  
Eduardo Rodrigues-Pinto ◽  
...  
Keyword(s):  
Preoperative Evaluation ◽  
Preoperative Staging ◽  
Final Diagnosis ◽  
Filling Defect ◽  
Biliary Strictures ◽  
Visualization System ◽  
Peroral Cholangioscopy ◽  
Impression Accuracy ◽  
Tertiary Center

Objectives: Peroral cholangioscopy (POC) has shown to be a useful diagnostic procedure in the evaluation of biliary strictures; however, data regarding its role on preoperative staging are scarce. The aim of this study was to evaluate POC role in the diagnosis and preoperative intraductal staging of perihilar cholangiocarcinoma (CCA). Methods: Retrospective study that included all patients who underwent POC with SpyGlassTM Direct Visualization System for the diagnosis of biliary strictures or for preoperative evaluation of extrahepatic biliary tumors, between 2015 and 2019, in a single tertiary center. Results: Forty-three patients were included, 63% male with a median age of 62 years. Thirty-eight (88.3%) underwent POC due to indeterminate biliary strictures, 3 (7%) due to bile duct filling defect, and 2 (4.7%) for intraductal staging of perihilar CCA. In the follow-up, a final diagnosis of malignancy was established in 56% of the patients. Visual impression accuracy with SpyGlass was 95.1% (with 100% sensitivity and 89.5% specificity). SpyBite biopsies accuracy was 80.5% (63.6% sensitivity and 100% specificity). In the 19 patients with a final perihilar CCA diagnosis, intraductal evaluation with SpyGlass altered anatomic classification (Bismuth-Corlette) defined by previous imagiologic findings in 8 (42.1%) patients. Alteration in anatomic classification changed therapeutic approach in 4 (21%). Conclusions: POC use for evaluating intraductal spread in potentially resectable perihilar CCA can detect more extensive and change surgical management. In the future, preoperative staging of perihilar CCA with POC combined with imagiologic evaluation of vascular extension of the lesions may optimize surgical results.

Using single-operator cholangioscopy for endoscopic evaluation of indeterminate biliary strictures: results from a large multinational registry

Endoscopy ◽  
2020 ◽  
Vol 52 (07) ◽  
pp. 574-582 ◽  
Author(s):  
Majid A. Almadi ◽  
Takao Itoi ◽  
Jong Ho Moon ◽  
Mahesh K. Goenka ◽  
Dong Wan Seo ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Life Experience ◽  
Real Life ◽  
Final Diagnosis ◽  
Filling Defect ◽  
Biliary Strictures ◽  
Single Operator ◽  
Duct Stricture ◽  
Malignant Diagnosis

Abstract Background Peroral cholangioscopy (POCS) of indeterminate biliary strictures aims to achieve a diagnosis through visual examination and/or by obtaining targeted biopsies under direct visualization. In this large, prospective, multinational, real-life experience of POCS-guided evaluation of indeterminate biliary strictures, we evaluated the performance of POCS in this difficult-to-manage patient population. Methods This prospective registry enrolled patients, with indeterminate biliary strictures across 20 centers in Asia, the Middle East, and Africa. The primary end points were the ability to visualize the lesion, obtain histological sampling when intended, and an assessment of the diagnostic accuracy of POCS for malignant strictures. Patients were followed for 6 months after POCS or until a definitive malignant diagnosis was made, whichever occurred first. Results 289 patients underwent 290 POCS procedures with intent to biopsy in 182 cases. The stricture/filling defect was successfully visualized in 286/290 (98.6 %), providing a visual diagnostic impression in 253/290 (87.2 %) and obtaining adequate biopsies in 169/182 (92.9 %). Procedure-related adverse events occurred in 5/289 patients (1.7 %). POCS influenced patient management principally by elucidating filling defects or the causes of bile duct stricture or dilation. The visual impression of malignancy showed 86.7 % sensitivity, 71.2 % specificity, 65.8 % positive and 89.4 % negative predictive value, and 77.2 % overall accuracy compared with final diagnosis. Histological POCS-guided samples showed 75.3 % sensitivity, 100 % specificity, 100 % positive and 77.1 % negative predictive value, and 86.5 % overall accuracy. Conclusion In this large, real-life, prospective series, POCS was demonstrated to be an effective and safe intervention guiding the management of patients with indeterminate biliary strictures.

scholarly journals The Role of Peroral Cholangioscopy in Evaluating Indeterminate Biliary Strictures

2019 ◽  
Vol 52 (6) ◽  
pp. 556-564 ◽  
Author(s):  
Nasim Parsa ◽  
Mouen A. Khashab
Keyword(s):  
Biliary Strictures ◽  
Peroral Cholangioscopy

scholarly journals B-Flow Twinkling Sign in Preoperative Evaluation of Cervical Lymph Nodes in Patients with Papillary Thyroid Carcinoma

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Giuseppina Napolitano ◽  
Antonio Romeo ◽  
Andrea Bianco ◽  
Maurizio Gasperi ◽  
Pio Zeppa ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Nodes ◽  
Preoperative Evaluation ◽  
Preoperative Staging ◽  
Final Diagnosis ◽  
Individual Therapy ◽  
Papillary Thyroid ◽  
Cervical Lymph Nodes ◽  
Cytologic Examination ◽  
Twinkling Sign

Papillary thyroid cancer (PTC) is the most common histologic type of differentiated thyroid cancer. The first site of metastasis is the cervical lymph nodes (LNs). The ultrasonography (US) is the best diagnostic method for the detection of cervical metastatic LNs. We use a new technique, B-flow imaging (BFI), recently used for evaluation of thyroid nodules, to estimate the presence of BFI twinkling signs (BFI-TS), within metastatic LNs in patients with PTC. Two hundred and fifty-two patients with known PTC were examined for preoperative evaluation with conventional US and BFI. Only 83 with at least one metastatic LN were included. All patients included underwent surgery; the final diagnosis was based on the results of histology. The following LN characteristics were evaluated: shape, abnormal echogenicity, absent hilum, calcifications, cystic appearance, peripheral vascularization, and BFI-TS. A total of 604 LNs were analyzed. Of these, 298 were metastatic, according to histopathology. The BFI-TS showed high values​​of specificity (99.7%) and sensitivity (80.9%). The combination of each conventional US sign with the BF-TS increases the specificity. Our findings suggest that BFI can be helpful in the selection of suspicious neck LNs that should be examined at cytologic examination for accurate preoperative staging and individual therapy selection.

scholarly journals Advances of Peroral Cholangioscopy and EUS for Indeterminate Biliary Lesions

2020 ◽  
Vol 25 (1) ◽  
pp. 29-33
Author(s):  
Yun Nah Lee
Keyword(s):  
Diagnostic Yield ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Biliary Strictures ◽  
Diagnostic Modality ◽  
Visualization System ◽  
Technical Performance ◽  
Peroral Cholangioscopy ◽  
Tailored Approach ◽  
Spyglass Direct Visualization System

Traditionally, biliary lesions have been considered to be indeterminate when a diagnosis cannot be made after basic laboratory work-up, abdominal imaging and endoscopic retrograde cholangiopancreatography (ERCP) with biliary sampling. Although ERCP is a first-line diagnostic modality for indeterminate biliary lesions, the diagnostic yield of ERCP-based tissue sampling is insufficient. In a recent, peroral cholangioscopy (POC)- guided forceps biopsy and endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) are evolving as reliable diagnostic procedures for indeterminate biliary lesions. In previous studies, EUS-FNA was sensitive and highly specific for diagnosing malignancy in biliary strictures. However, EUS-FNA has several limitations as a routine clinical procedure for all biliary strictures. Newly developed POC systems, such as the SpyGlass direct visualization system and direct POC using an ultra-slim endoscope, have led to excessive improvements in technical performance and diagnostic yields for biliary strictures. However, the performance of POC-guided target biopsy for distal bile duct strictures is technically difficult, and this approach has a limited ability to diagnose biliary strictures caused by non-intraductal, extrinsic compressed malignancies, such as a pancreatic cancer. Therefore, a tailored approach using optimized endoscopic modalities that are specific to the characteristics of a given biliary stricture is needed to achieve a high diagnostic yield for indeterminate biliary lesions.

THE ROLE OF “ROSE” FOR ERCP-GUIDED BRUSHING ON INDETERMINATE BILIARY STRICTURES: EXPERIENCE OF A REFERRAL CENTER

2019 ◽  
Author(s):  
L Archibugi ◽  
A Mariani ◽  
B Ciambriello ◽  
MC Petrone ◽  
G Rossi ◽  
...  
Keyword(s):  
Biliary Strictures ◽  
Referral Center

scholarly journals The Utility of Rapid On-Site Evaluation during Bronchoscopic Biopsy: A 2-Year Respiratory Endoscopy Central Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Hansheng Wang ◽  
Na Wei ◽  
Yijun Tang ◽  
Yunyun Wang ◽  
Guoshi Luo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
International Association ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
European Respiratory Society ◽  
Macroscopic Appearance ◽  
Visible Lesion ◽  
Bronchoscopic Biopsy ◽  
Site Evaluation

Background. Rapid on-site evaluation (ROSE) is commonly used to evaluate the adequacy of biopsy materials in fine-needle aspiration; however, the diagnostic performance of ROSE during fiber optic bronchoscopy (FOB) biopsy under direct vision is rarely reported. Here, we evaluated the role of ROSE during FOB biopsy of visible lesion in trachea or bronchi. Methods. The role of ROSE was prospectively evaluated in consecutive bronchoscopy specimens obtained between January 2016 and January 2018. The agreement and accuracy between ROSE and final histopathological interpretation were assessed. The frequency and possible reasons for discrepancy between ROSE and definitive histopathology results were identified. Histological and cytological classification was performed according to the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society (IASLC/ATS/ERS) criteria of lung ADCs classification. Results. The study enrolled 651 patients, of which 33 were excluded because of insufficient cells. Final diagnosis of malignancy was achieved in 462 cases (74.8%), whereas 156 cases (25.2%) were nonmalignant. ROSE and pathology were well correlated for the diagnosis of squamous cell carcinoma (SCC) (Kappa = 0.718, p<0.05), adenocarcinoma (AdC) (Kappa = 0.662; p<0.05) and small cell lung cancer (SCLC) (Kappa = 0.955; p<0.05). In 24 cases diagnosed as malignant by ROSE and nonmalignant by pathology, the lesion tissues were surgically excised and re-analyzed, and the 24 cases were finally confirmed as malignant by pathology. Conclusions. ROSE technique allows bronchoscopists to obtain viable and adequate material for the diagnosis of histopathology, and provides them with an onsite preliminary diagnosis especially in cases with inconclusive macroscopic appearance. ROSE and pathology should be used in combination to increase the accuracy of diagnosis.

Sa1506 PerOral Cholangioscopy for the Evaluation of Indeterminate Biliary Strictures: A Single Center Experience

2011 ◽  
Vol 73 (4) ◽  
pp. AB191
Author(s):  
Pari M. Shah ◽  
Supriya Rao ◽  
Gregory G. Ginsberg ◽  
Nuzhat A. Ahmad ◽  
David L. Jaffe ◽  
...  
Keyword(s):  
Single Center ◽  
Biliary Strictures ◽  
Peroral Cholangioscopy ◽  
Single Center Experience
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