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2015 ; 3
(3
): 209-15
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Endoscopic ultrasound in the diagnosis of cholangiocarcinoma as the etiology of
biliary strictures: a systematic review and meta-analysis
#MMPMID25169922
Navaneethan U
; Njei B
; Venkatesh PG
; Lourdusamy V
; Sanaka MR
Gastroenterol Rep (Oxf)
2015[Aug]; 3
(3
): 209-15
PMID25169922
show ga
BACKGROUND AND AIM: Extrahepatic cholangiocarcinoma (CCA) typically presents as
biliary strictures. Endoscopic ultrasound (EUS)-fine needle aspiration (FNA) may
contribute to the diagnosis of CCA as the etiology of extrahepatic biliary
strictures. Our aim was to study the uselfulness of EUS-FNA in diagnosing CCA as
the etiology of biliary strictures. PATIENTS AND METHODS: In this meta-analysis,
PUBMED and EMBASE databases were examined to find studies published to April 2014
where diagnostic correlation of CCA was available. Studies reporting only
"positive for malignancy" were included in our analysis. The main outcome
measurements were sensitivity, specificity and likelihood ratio. RESULTS: Six
studies were included, covering 196 patients. The overall pooled sensitivity and
negative likelihood ratio (LR-) of EUS-FNA for diagnosis of CCA were 66% [95%
confidence interval (CI) 57-74%] and 0.34 (95% CI 0.26-0.43), respectively. In
five studies (146 patients), where a mass lesion was detected during EUS, the
pooled sensitivity and LR- of EUS-FNA for diagnosis of CCA were 80% [95% CI
72-87%] and 0.20 (95% CI 0.13-0.28), respectively. In the 49 patients with a
negative brush cytology, the pooled sensitivity and LR- of EUS-FNA for diagnosis
of CCA were 59% [95% CI 44-73%] and 0.41 (95% CI 0.27-0.56), respectively.
CONCLUSIONS: Our study suggests that EUS-FNA is useful in the evaluation of CCA
as the etiology of biliary strictures. EUS-FNA may improve the diagnosis of CCA
in patients with negative cytology and no mass on cross-sectional imaging.