EUS guided fine needle aspiration is useful in diagnostic evaluation of indeterminate proximal biliary strictures

Naveen B. Krishna, Pavan Tummala, Jennifer L. Labundy, Banke Agarwal

Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, USA.

DOI: 10.4236/ojgas.2012.22008                

Abstract

Background and Aim: Determination of the etiology of proximal biliary strictures (PBS) still remains a challenge. Even though EUS-FNA is potentially useful, its role in diagnostic evaluation of PBS is still not established due to a lack of sufficient data. We sought to determine the performance characteristics of EUS-FNA in patients with obstructive jaundice (ObJ) and PBS. Patients and Methods: This is a retrospective analysis and included patients with ObJ and PBS with non-diagnostic brush cytology, who underwent EUS-FNA in our university based practice from March 2002 to February 2009. We evaluated the final diagnoses in study patients and the performance characteristics of EUS-FNA for identifying malignant PBS. Final diagnosis was based on surgical pathology or clinical follow-up of at least 12 months. Results: The study included 28 patients (17 male, 11 female) with mean age of 62.4 ± 14.9 years. The strictures ranged from 10 - 70 mm in length. CT scan identified a hilar mass in 9 patients. EUS-FNA identified malignancy in 12 patients. 18 patients were finally diagnosed to have a malignant stricture and 10 patients had a benign stricture. There were 6 false negative diagnoses. The accuracy of EUS-FNA for diagnosis of cholangiocarcinoma was 78.6%, with 66.6% sensitivity, 100% specificity, 62.5% NPV and 100% PPV. Conclusions: EUS-FNA can diagnose malignancy in 66.6% of jaundiced patients with PBS and non-diagnostic brush cytology and may have a role in their further diagnostic evaluation.

Keywords

EUS-FNA; Cholangiocarcinoma; Proximal Biliary Strictures

Conflicts of Interest

The authors declare no conflicts of interest.

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