EUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction: results of a prospective, single-blind, comparative study

• Published in: Gastrointestinal endoscopy Vol. 80; no. 1; pp. 97 - 104
• Main Authors: Weilert, Frank, MD, Bhat, Yasser M., MD, Binmoeller, Kenneth F., MD, Kane, Steve, BS, Jaffee, Ian M., MD, Shaw, Richard E., PhD, Cameron, Rees, MD, Hashimoto, Yusuke, MD, Shah, Janak N., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.07.2014
• Subjects: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms - complications; Bile Duct Neoplasms - diagnosis; Bile Ducts, Intrahepatic - diagnostic imaging; Bile Ducts, Intrahepatic - pathology; Cholangiocarcinoma - complications; Cholangiocarcinoma - diagnosis; Cholangiopancreatography, Endoscopic Retrograde; Cholestasis - etiology; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Gallbladder Neoplasms - complications; Gallbladder Neoplasms - diagnosis; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - diagnosis; Pancreatitis - complications; Pancreatitis - diagnosis; Prospective Studies; Sensitivity and Specificity; Single-Blind Method; EUS-FNA; EUS-guided FNA
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2013.12.031

Background Both EUS and ERCP sampling techniques may provide tissue diagnoses in suspected malignant biliary obstruction. However, there are scant data comparing these 2 methods. Objective To compare EUS-guided FNA (EUS-FNA) and ERCP tissue sampling for the diagnosis of malignant biliary obstruction. Design Prospective, comparative, single-blind study. Setting Tertiary center. Patients Fifty-one patients undergoing same-session EUS and ERCP for the evaluation of malignant biliary obstruction over a 1-year period. Interventions EUS-FNA and ERCP tissue sampling with biliary brush cytology and intraductal forceps biopsies. Main Outcome Measurements Diagnostic sensitivity and accuracy of each sampling method compared with final diagnoses. Results EUS-FNA was more sensitive and accurate than ERCP tissue sampling ( P  < .0001) in 51 patients with pancreatic cancers (n = 34), bile duct cancers (n = 14), and benign biliary strictures (n = 3). The overall sensitivity and accuracy were 94% and 94% for EUS-FNA, and 50% and 53% for ERCP sampling, respectively. EUS-FNA was superior to ERCP tissue sampling for pancreatic masses (sensitivity, 100% vs 38%; P  < .0001) and seemed comparable for biliary masses (79% sensitivity for both) and indeterminate strictures (sensitivity, 80% vs 67%). Limitations Single-center study. Conclusion EUS-FNA is superior to ERCP tissue sampling in evaluating suspected malignant biliary obstruction, particularly for pancreatic masses. EUS-FNA appears similar to ERCP sampling for biliary tumors and indeterminate strictures. Given the superior performance characteristics of EUS-FNA and the higher incidence of pancreatic cancer compared with cholangiocarcinoma, EUS-FNA should be performed before ERCP in all patients with suspected malignant biliary obstruction. (Clinical trial registration number: NCT01356030 .)