Triple-tissue sampling at ERCP in malignant biliary obstruction

Background: Procurement of cytologic samples by brushing is common practice at endoscopic retrograde cholangiopancreatography (ERCP) but has low sensi tivity for cancer detection. Limited data are available on other techniques , including endoluminal fine-needle aspiration and forceps biopsy. This ser ies reviews the yield of these three stricture sampling methods. Methods: In this prospective study, patients with biliary obstruction with a clinical suspicion of malignancy underwent triple-tissue sampling at one ERCP session. Final cancer diagnosis was based on all sampling methods plus surgery, autopsy, and clinical follow-up. Tissue specimens were reported a s normal, atypia, or malignant. Results: A total of 133 patients were evaluated: 104 had cancer and 29 had benign strictures. Tissue sampling sensitivity varied according to the type of cancer; the highest yield was seen in ampullary cancers (62% to 85%). T he cumulative sensitivity of triple-tissue sampling in the cancer patients was as follows: sensitivity was 52% if atypia was considered benign and 77% if it was considered malignant. The addition of a second or third techniqu e increased sensitivity rates in most instances. No serious complications o ccurred from the tissue sampling methods. Conclusions: Tissue sampling sensitivity varied according to the type of ca ncer. Combining a second or third method increased sensitivity; general use of at least two sampling methods is therefore recommended.