Diagnostic yields and clinical impact of endoscopic ultrasound-guided tissue acquisition for biliary lesions.

Background/purpose: Diagnostic yields of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for biliary lesions have not been fully established due to limited evidence. We aimed to clarify the efficacy of EUS-TA for biliary lesions.

Methods: Diagnostic yields and adverse event rates of EUS-TA for biliary lesions were evaluated. The subject cases were only limited to cases in which the biliary lesions itself was punctured. Diagnostic yields of endoscopic retrograde cholangiography (ERC)-guided biopsy/cytology performed within the same period were also evaluated to assess the additional effect of EUS-TA.

Results: EUS-TA was attempted in 71 cases (28 hilar bile duct, 19 distal bile duct, 4 ampulla of Vater, and 20 gallbladder), and the final diagnosis was malignant in 54 cases (76.1%). The sensitivity, specificity, and accuracy of EUS-TA were 96.3% (52/54), 100% (17/17), and 97.2% (69/71), respectively. Adverse events were observed in one case (1.4%, peritonitis). The accuracy of ERC biopsy/cytology was 82.5% (212/257 cases); additional EUS-TA diagnosed 30 cases as malignant additionally and improved the accuracy (94.2%; 242/257 cases; p < .01).

Conclusions: EUS-TA is an accurate and safe diagnostic test for biliary lesions. The addition of EUS-TA may be considered when there is a suspicion of a false-negative ERC result.