P224 Biopsy significantly improves the diagnostic yield of pancreato-biliary cancers: a single centre experience

Le résumé fourni par la source

Introduction Despite advances in the management, Pancreato-Biliary (PB) cancers are associated with poor 5-year survival. Due to their location and the initial non-specific symptoms, time to diagnosis is significantly higher compared to other cancers. Standard-of-care confirmation of diagnosis is through brush cytology, which is often inadequate. Hence, patients often undergo multiple procedures to reach definitive diagnosis. Tissue acquisition through either bile duct biopsies or endoscopic ultrasound (EUS) guided needle biopsies improve the diagnostic yield. We evaluated the diagnostic yield of all cytology and biopsy in PB cancer. Methods All consecutive patients who were investigated for bile duct strictures between January 2022 and January 2024 in Nottingham University Hospitals NHS Trust were reviewed. Patients were included if they either had biliary brushing or biopsies acquired via endoscopic retrograde cholangiopancreatography (ERCP), EUS or percutaneous transhepatic cholangiogram (PTC). Repeat procedures on the same patient were counted only if repeat sampling was done. Patient demographics, cytology results, histology results and final multidisciplinary meeting (MDM) diagnosis were collected. Cytology was considered as positive for cancer if it was reported as C5; MDM diagnosis, which is based on imaging, histopathology, tumour markers was considered the definitive diagnosis. Sensitivity, specificity, positive predictive and negative predictive values (PPV, NPV) were calculated for both cytology and biopsy using SPSS software. Results 315 consecutive PTC, EUS and ERCP procedures were reviewed; of these, 106 did not include sampling and were excluded. Two hundred nine procedure samples from 179 patients were included in the analysis. The median age was 72 (IQR 17.0); the majority were males (n=104, 58%). The sensitivity, specificity, PPV and NPV for cytology and biopsies are described below. The average number of brushings were similar between PTC and ERCP (1.26 [SD 0.75] vs 1.08 [SD 0.43]); similarly, the average number of PTC procedures and ERCP procedures required to obtain a diagnosis sample were similar (1.35 [SD0.79] vs. 1.21 [SD0.53]) Conclusions The diagnostic yield of biopsy specimens is significantly better compared to cytology for all PB cancers together and individually. Obtaining biopsy specimens may lead to earlier diagnosis, minimize the number of procedures required and aid molecular analysis.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.