NEW YORK (Reuters Health) – Having an on-site pathologist interpret tissue samples at endoscopic retrograde cholangiopancreatography (ERCP) can lead to immediate diagnosis, researchers report in the November 23rd on-line paper in the American Journal of Gastroenterology.
Dr. Douglas A. Howell and colleagues at Maine Medical Center, Portland, and colleagues note that overall, “Techniques of tissue sampling at ERCP have been underutilized due to technical demands, low yield, and lack of immediate intraprocedural diagnosis.”
Taking the lead from intraoperative sampling of brain tumors, the researchers developed a technique of “smashing” forceps biopsies of suspicious biliary strictures between two glass slides and preparing them to be read by a pathologist in the ERCP suite.
To examine the utility of the approach, the team retrospectively examined the results in 133 ERCP patients with suspicious biliary strictures and without prior tissue diagnosis. They underwent ERCP between 2004 and 2009.
In all, immediate cytological diagnosis was made in 84 (72%) of the 117 patients eventually proven to have malignancy.
True-positive results of the “Smash” protocol were seen in 74% of cases of pancreatic cancer, 79% of cholangiocarcinoma, 53% of metastatic cancer and 57% of other of other malignancies.
To date, only brush cytology has had general use at ERCP, the researchers observe and “yield has been disappointingly low.”
Forceps placement at ERCP is extremely accurate, they point out, and is comparable to that with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA).
Moreover, reported yields are comparable to EUS FNA, and compared to that technique or CT-guided biopsy, Smash is significantly less expensive.
Also, Dr. Howell told Reuters Health by email, “This technique is applicable world wide and EUS still has limited availability.”
“In cases of obstructive jaundice with obvious metastatic disease,” he added, “Smash permits a single procedure as EUS not needed for staging. Smash saves time, scheduling and cost in that setting.” Moreover, it is safe.
Reference:
Intraprocedural Tissue Diagnosis During ERCP Employing a New Cytology Preparation of Forceps Biopsy
Am J Gastroenterol 2010.
