P-HPB-10: A prospective comparative study of efficacy of endoscopic ultrasound-guided fine needle aspiration versus endoscopic retrograde cholangiopancreatography-guided brush cytology in attainment of histopathology of distal common bile duct masses

OBJECTIVES: To study the efficacy of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) for attaining tissue from distal CBD masses and comparing it to endoscopic retrograde cholangiopancreatography (ERCP)-guided brush cytology from mass. METHODS: Fifty-six cases with distal bile duct mass with obstructive jaundice in the last 3 years were taken for the study. First EUS was done with a linear echoendoscope, mass was identified, FNA was performed with a 25-gauge needle making at 2–5 passes, and then material was sent for cytology. The same patients then subjected to ERCP and brush cytology was taken making 2–3 passes. RESULTS: Cases 56, age range 57.2+/-13.6, 40 males, mean serum bilirubin 9 mg/dl, mean size of mass 12 mm (7-30mm). Mean number of passes with fine needle aspiration (FNA) needle was 2.5 (2–5 passes). Mean number of passes with cytology brush was 2 (2–5). Positive diagnosis obtained with FNA was 47 (83.9%). Positive diagnosis obtained by brush was 34 (60.7%). Positive diagnosis was reached in more patients with FNA compared to cytology ( malignancy 80.8% vs 67.6%, suspicious for malignancy 10.6% vs 20.5%, and benign 8.5% vs 8.5%). CONCLUSIONS: EUS FNA is a very effective method for diagnosis of distal bile duct masses. Its efficacy is better than ERCP-guided brush cytology. Even small masses are amenable to FNA using EUS guidance. Male over 57 years with jaundice and distal bile duct obstruction has a very likelihood of have a distal CBD cholangiocarcinoma.