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Triple-Tissue Sampling during Endoscopic Retrograde Cholangiopancreatography Increases the Overall Diagnostic Sensitivity for Cholangiocarcinoma.
[cholangiocarcinoma]
There
are
several
methods
for
obtaining
tissue
samples
to
diagnose
malignant
biliary
strictures
during
endoscopic
retrograde
cholangiopancreatography
(
ERCP
)
.
However
,
each
method
has
only
limited
sensitivity
.
This
study
aimed
to
evaluate
the
diagnostic
accuracy
of
a
combined
triple-tissue
sampling
(
TTS
)
method
(
on-site
bile
aspiration
cytology
,
brush
cytology
,
and
forceps
biopsy
)
.
We
retrospectively
reviewed
168
patients
with
suspicious
malignant
biliary
strictures
who
underwent
double
-tissue
sampling
(
DTS
;
n
=
121
)
or
TTS
(
n
=
47
)
via
ERCP
at
our
institution
from
2004
to
2011
.
Among
the
168
patients
reviewed
,
117
patients
(
69
.
6
%
)
were
eventually
diagnosed
with
malignancies
.
The
diagnostic
sensitivity
for
cancer
was
significantly
higher
in
the
TTS
group
than
the
DTS
group
(
85
.
0
%
vs
64
.
9
%
,
respectively
;
p
=
0
.
022
)
.
Furthermore
,
the
combination
of
brush
cytology
and
forceps
biopsy
was
superior
to
the
other
method
combinations
in
the
DTS
group
.
With
respect
to
cancer
type
(
cholangiocarcinoma
vs
noncholangiocarcinoma
)
,
interestingly
,
the
diagnostic
sensitivity
was
higher
for
cholangiocarcinoma
in
the
TTS
group
than
the
DTS
group
(
100
%
vs
69
.
4
%
,
respectively
;
p
<
0
.
001
)
but
not
for
the
non-
cholangiocarcinoma
patients
(
57
.
1
%
vs
57
.
1
%
,
respectively
)
.
TTS
can
provide
an
improved
diagnostic
accuracy
in
suspicious
malignant
biliary
strictures
,
particularly
for
cholangiocarcinoma
.
Diseases
Validation
Diseases presenting
"aspiration"
symptom
adrenal incidentaloma
allergic bronchopulmonary aspergillosis
carcinoma of the gallbladder
cholangiocarcinoma
congenital diaphragmatic hernia
cowden syndrome
cushing syndrome
cutaneous mastocytosis
dedifferentiated liposarcoma
erdheim-chester disease
esophageal squamous cell carcinoma
familial hypocalciuric hypercalcemia
focal myositis
hodgkin lymphoma, classical
legionellosis
liposarcoma
megacystis-microcolon-intestinal hypoperistalsis syndrome
neonatal adrenoleukodystrophy
pleomorphic liposarcoma
pyomyositis
waldenström macroglobulinemia
well-differentiated liposarcoma
x-linked adrenoleukodystrophy
This symptom has already been validated