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World J Gastroenterol. Feb 21, 2008; 14(7): 1097-1101
Published online Feb 21, 2008. doi: 10.3748/wjg.14.1097
Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma
Andreas Weber, Claus von Weyhern, Falko Fend, Jochen Schneider, Bruno Neu, Alexander Meining, Hans Weidenbach, Roland M Schmid, Christian Prinz
Andreas Weber, Jochen Schneider, Bruno Neu, Alexander Meining, Hans Weidenbach, Roland M Schmid, Christian Prinz, Department of Internal Medicine II, Technical University of Munich, Munich 81675, Germany
Claus von Weyhern, Falko Fend, Department of Pathology, Technical University of Munich, Munich 81675, Germany
Author contributions: Weber A, Weidenbach H, Schmid RM, and Prinz C designed research; Schneider J, Neu B, Meining A, von Weyhern C, and Fend F performed research; Weber A, Schneider J, Weidenbach H and Prinz C analyzed data; Weber A, Schmid RM, von Weyhern C, and Prinz C wrote the paper.
Correspondence to: Professor Christian Prinz, Department of Internal Medicine II, Technical University of Munich, Ismaningerstrasse 22, München 81675, Germany. christian.prinz@lrz.tum.de
Telephone: +49-89-41405973
Fax: +49-89-41407366
Received: September 14, 2007
Revised: January 8, 2008
Published online: February 21, 2008
Abstract

AIM: To evaluate the sensitivity of brush cytology and forceps biopsy in a homogeneous patient group with hilar cholangiocarcinoma.

METHODS: Brush cytology and forceps biopsy were routinely performed in patients with suspected malignant biliary strictures. Fifty-eight consecutive patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) including forceps biopsy and brush cytology in patients with hilar cholangiocarcinoma between 1995-2005.

RESULTS: Positive results for malignancy were obtained in 24/58 patients (41.4%) by brush cytology and in 31/58 patients (53.4%) by forceps biopsy. The combination of both techniques brush cytology and forceps biopsy resulted only in a minor increase in diagnostic sensitivity to 60.3% (35/58 patients). In 20/58 patients (34.5%), diagnosis were obtained by both positive cytology and positive histology, in 11/58 (19%) by positive histology (negative cytology) and only 4/58 patients (6.9%) were confirmed by positive cytology (negative histology).

CONCLUSION: Brush cytology and forceps biopsy have only limited sensitivity for the diagnosis of malignant hilar tumors. In our eyes, additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings.

Keywords: Brush cytology; Forceps biopsy; Cholangiocarcinoma; Klatskin tumor; Endoscopy; Diagnostic approaches