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CCA Diagnostic Tools Reviewed for Comparative Sensitivity
Researchers concluded that endoscopic retrograde cholangiopancreatography (ERCP)-guided brush cytology biopsy, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) showed “modest” sensitivity in the diagnosis of cholangiocarcinoma (CCA).
The investigators conducted a comprehensive literature search for studies of CCA diagnostic techniques published between January 1995 and August 2020. They assessed the pooled rates of sensitivity CCA diagnosis as well as for adverse events among brushing, biopsy, brushing and biopsy combined, and EUS-FNA.
In 32 studies 1123 patients with CCA were diagnosed by brushing; 719 patients in 20 studies underwent biopsy; 358 patients in 13 studies were tested by combined brushing and biopsy; and 422 patients om 17 studies were tested by EUS-FNA.
Pooled diagnostic sensitivities were 56.0% with brushing (95% confidence interval [CI] 48.8-63.1%, I2 = 83.0%); 67.0% with biopsy (95% CI 60.2-73.5%, I2 = 72.5%); 70.7% with brushing and biopsy (95% CI 64.1-76.8%, I2 = 42.7%); and 73.6% with EUS-FNA (95% CI 64.7-81.5%, I2 = 74.7%).
The diagnostic sensitivity was significantly lower for brushing than for the other diagnostic methods, the researchers noted. The findings revealed no significant difference diagnostic sensitivities among biopsy, brushing and biopsy, and EUS-FNA and adverse events were comparable among the groups.
“Intraductal biopsy, brushing & biopsy, and EUS-FNA had comparable efficacy and safety for the diagnosis of CCA. Brushing was the least sensitive diagnostic tool compared with intraductal biopsy or EUS-FNA,” the authors reported. “Given the modest diagnostic sensitivities of intraductal biopsy and EUS-FNA in the diagnosis of CCA, further studies for complementing these techniques with biomarkers may be needed.”
—Rebecca Mashaw
Reference:
Yoon SB, Moon SH, Ko SW, Lim H, Kang HS, Kim JH. Brush cytology, forceps biopsy, or endoscopic ultrasound-guided sampling for diagnosis of bile duct cancer: A meta-analysis. Dig Dis Sci. 2022;67(7):3284-3297.
