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  • Title: Endoscopic tissue diagnosis of cholangiocarcinoma.
    Author: Harewood GC.
    Journal: Curr Opin Gastroenterol; 2008 Sep; 24(5):627-30. PubMed ID: 19122506.
    Abstract:
    PURPOSE OF REVIEW: The extremely poor outcome in patients with cholangiocarcinoma, in large part, reflects the late presentation of these tumors and the challenging nature of establishing a tissue diagnosis. Establishing a diagnosis of cholangiocarcinoma requires obtaining evidence of malignancy from sampling of the epithelium of the biliary tract, which has proven to be challenging. Although endoscopic ultrasound-guided fine needle aspiration performs slightly better than endoscopic retrograde cholangiopancreatography in diagnosing cholangiocarcinoma, both endoscopic approaches demonstrate disappointing performance characteristics. RECENT FINDINGS: The limitations of cytologic analysis have recently led to the evaluation of new technologies such as digital image analysis and fluorescence in-situ hybridization to enhance diagnostic sensitivity. Both of these approaches carry the ability to identify malignant cells in samples of limited cellularity and thereby provide enhanced diagnostic sensitivity. SUMMARY: Overall, recognizing the limited sensitivity of diagnostic approaches for tissue diagnosis of cholangiocarcinoma, it would appear prudent to pursue further tissue sampling when there is a strong clinical suspicion of malignancy despite a prior negative/nondiagnostic result.
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