caa a22 4500 445797525 CHVBK 20180317145130.0 cr unu---uuuuu 170323e20110201xx s 000 0 eng 10.1007/s10620-010-1535-4 doi (NATIONALLICENCE)springer-10.1007/s10620-010-1535-4 A Novel Method of Forceps Biopsy Improves the Diagnosis of Proximal Biliary Malignancies [Elektronische Daten] [Hasan Kulaksiz, Pavel Strnad, Achim Römpp, Guido von Figura, Thomas Barth, Irene Esposito, Peter Schirmacher, Doris Henne-Bruns, Guido Adler, Adolf Stiehl] Background and Aims: Tissue specimen collection represents a cornerstone in diagnosis of proximal biliary tract malignancies offering great specificity, but only limited sensitivity. To improve the tumor detection rate, we developed a new method of forceps biopsy and compared it prospectively with endoscopic transpapillary brush cytology. Patients and Methods: 43 patients with proximal biliary stenoses, which were suspect for malignancy, undergoing endoscopic retrograde cholangiography were prospectively recruited and subjected to both biopsy [using a double-balloon enteroscopy (DBE) forceps under a guidance of a pusher and guiding catheter with guidewire] and transpapillary brush cytology. The cytological/histological findings were compared with the final clinical diagnosis. Results: 35 out of 43 patients had a malignant disease (33 cholangiocarcinomas, 1 hepatocellular carcinoma, 1 gallbladder carcinoma). The sensitivity of cytology and biopsy in these patients was 49 and 69%, respectively. The method with DBE forceps allowed a pinpoint biopsy of the biliary stenoses. Both methods had 100% specificity, and, when combined, 80% of malignant processes were detected. All patients with non-malignant conditions were correctly assigned by both methods. No clinically relevant complications were observed. Conclusions: The combination of forceps biopsy and transpapillary brush cytology is safe and offers superior detection rates compared to both methods alone, and therefore represents a promising approach in evaluation of proximal biliary tract processes. Springer Science+Business Media, LLC, 2011 Cholangiocarcinoma nationallicence Double-balloon enteroscopy nationallicence Endoscopic retrograde cholangiography nationallicence CCC : Cholangiocarcinoma nationallicence DBE : Double-balloon enteroscopy nationallicence ERC : Endoscopic retrograde cholangiography nationallicence EUS-FNA : Endoscopic ultrasonography-guided fine-needle aspiration nationallicence HCC : Hepatocellular carcinoma nationallicence H&E : Hematoxylin and eosin nationallicence PAS : Periodic Acid Schiff nationallicence PSC : Primary sclerosing cholangitis nationallicence Kulaksiz Hasan Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany aut Strnad Pavel Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany aut Römpp Achim Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany aut von Figura Guido Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany aut Barth Thomas Department of Pathology, University Medical Center Ulm, Ulm, Germany aut Esposito Irene Institute of Pathology, Technische Universität München, Munich, Germany aut Schirmacher Peter Institute of Pathology, University Medical Center Ulm, Ulm, Germany aut Henne-Bruns Doris Department of Surgery, University Medical Center Ulm, Ulm, Germany aut Adler Guido Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany aut Stiehl Adolf Department of Internal Medicine, Division of Gastroenterology, University Medical Center Heidelberg, Heidelberg, Germany aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/2(2011-02-01), 596-601 0163-2116 56:2<596 2011 56 10620 https://doi.org/10.1007/s10620-010-1535-4 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-010-1535-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kulaksiz Hasan Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany aut NATIONALLICENCE 700 1- Strnad Pavel Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany aut NATIONALLICENCE 700 1- Römpp Achim Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany aut NATIONALLICENCE 700 1- von Figura Guido Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany aut NATIONALLICENCE 700 1- Barth Thomas Department of Pathology, University Medical Center Ulm, Ulm, Germany aut NATIONALLICENCE 700 1- Esposito Irene Institute of Pathology, Technische Universität München, Munich, Germany aut NATIONALLICENCE 700 1- Schirmacher Peter Institute of Pathology, University Medical Center Ulm, Ulm, Germany aut NATIONALLICENCE 700 1- Henne-Bruns Doris Department of Surgery, University Medical Center Ulm, Ulm, Germany aut NATIONALLICENCE 700 1- Adler Guido Department of Internal Medicine I, Center for Internal Medicine, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany aut NATIONALLICENCE 700 1- Stiehl Adolf Department of Internal Medicine, Division of Gastroenterology, University Medical Center Heidelberg, Heidelberg, Germany aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/2(2011-02-01), 596-601 0163-2116 56:2<596 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer