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Optimal tissue sampling during ERCP and emerging molecular techniques for the differentiation of benign and malignant biliary strictures
Patients with cholangiocarcinoma have poor survival since the majority of patients are diagnosed at a stage precluding surgical resection, due to locally irresectable tumors and/or metastases. Optimization of diagnostic strategies, with a principal role for tissue diagnosis, is essential to detect c...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053835/ https://www.ncbi.nlm.nih.gov/pubmed/33948111 http://dx.doi.org/10.1177/17562848211002023 |
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author | Kamp, Eline J. C. A. Dinjens, Winand N. M. Doukas, Michail Bruno, Marco J. de Jonge, Pieter Jan F. Peppelenbosch, Maikel P. de Vries, Annemarie C. |
author_facet | Kamp, Eline J. C. A. Dinjens, Winand N. M. Doukas, Michail Bruno, Marco J. de Jonge, Pieter Jan F. Peppelenbosch, Maikel P. de Vries, Annemarie C. |
author_sort | Kamp, Eline J. C. A. |
collection | PubMed |
description | Patients with cholangiocarcinoma have poor survival since the majority of patients are diagnosed at a stage precluding surgical resection, due to locally irresectable tumors and/or metastases. Optimization of diagnostic strategies, with a principal role for tissue diagnosis, is essential to detect cancers at an earlier stage amenable to curative treatment. Current barriers for a tissue diagnosis include both insufficient tissue sampling and a difficult cyto- or histopathological assessment. During endoscopic retrograde cholangiopancreatography, optimal brush sampling includes obtaining more than one brush within an individual patient to increase its diagnostic value. Currently, no significant increase of the diagnostic accuracy for the new cytology brush devices aiming to enhance the cellularity of brushings versus standard biliary brush devices has been demonstrated. Peroral cholangioscopy with bile duct biopsies appears to be a valuable tool in the diagnostic work-up of indeterminate biliary strictures, and may overcome current technical difficulties of fluoroscopic-guided biopsies. Over the past years, molecular techniques to detect chromosomal instability, mutations and methylation profiling of tumors have revolutionized, and implementation of these techniques on biliary tissue during diagnostic work-up of biliary strictures may be awaited in the near future. Fluorescence in situ hybridization has already been implemented in routine diagnostic evaluation of biliary strictures in several centers. Next-generation sequencing is promising for standard diagnostic care in biliary strictures, and recent studies have shown adequate detection of prevalent genomic alterations in KRAS, TP53, CDKN2A, SMAD4, PIK3CA, and GNAS on biliary brush material. Detection of DNA methylation of tumor suppressor genes and microRNAs may evolve over the coming years to a valuable diagnostic tool for cholangiocarcinoma. This review summarizes optimal strategies for biliary tissue sampling during endoscopic retrograde cholangiopancreatography and focuses on the evolving molecular techniques on biliary tissue to improve the differentiation of benign and malignant biliary strictures. |
format | Online Article Text |
id | pubmed-8053835 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-80538352021-05-03 Optimal tissue sampling during ERCP and emerging molecular techniques for the differentiation of benign and malignant biliary strictures Kamp, Eline J. C. A. Dinjens, Winand N. M. Doukas, Michail Bruno, Marco J. de Jonge, Pieter Jan F. Peppelenbosch, Maikel P. de Vries, Annemarie C. Therap Adv Gastroenterol Review Patients with cholangiocarcinoma have poor survival since the majority of patients are diagnosed at a stage precluding surgical resection, due to locally irresectable tumors and/or metastases. Optimization of diagnostic strategies, with a principal role for tissue diagnosis, is essential to detect cancers at an earlier stage amenable to curative treatment. Current barriers for a tissue diagnosis include both insufficient tissue sampling and a difficult cyto- or histopathological assessment. During endoscopic retrograde cholangiopancreatography, optimal brush sampling includes obtaining more than one brush within an individual patient to increase its diagnostic value. Currently, no significant increase of the diagnostic accuracy for the new cytology brush devices aiming to enhance the cellularity of brushings versus standard biliary brush devices has been demonstrated. Peroral cholangioscopy with bile duct biopsies appears to be a valuable tool in the diagnostic work-up of indeterminate biliary strictures, and may overcome current technical difficulties of fluoroscopic-guided biopsies. Over the past years, molecular techniques to detect chromosomal instability, mutations and methylation profiling of tumors have revolutionized, and implementation of these techniques on biliary tissue during diagnostic work-up of biliary strictures may be awaited in the near future. Fluorescence in situ hybridization has already been implemented in routine diagnostic evaluation of biliary strictures in several centers. Next-generation sequencing is promising for standard diagnostic care in biliary strictures, and recent studies have shown adequate detection of prevalent genomic alterations in KRAS, TP53, CDKN2A, SMAD4, PIK3CA, and GNAS on biliary brush material. Detection of DNA methylation of tumor suppressor genes and microRNAs may evolve over the coming years to a valuable diagnostic tool for cholangiocarcinoma. This review summarizes optimal strategies for biliary tissue sampling during endoscopic retrograde cholangiopancreatography and focuses on the evolving molecular techniques on biliary tissue to improve the differentiation of benign and malignant biliary strictures. SAGE Publications 2021-04-15 /pmc/articles/PMC8053835/ /pubmed/33948111 http://dx.doi.org/10.1177/17562848211002023 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Review Kamp, Eline J. C. A. Dinjens, Winand N. M. Doukas, Michail Bruno, Marco J. de Jonge, Pieter Jan F. Peppelenbosch, Maikel P. de Vries, Annemarie C. Optimal tissue sampling during ERCP and emerging molecular techniques for the differentiation of benign and malignant biliary strictures |
title | Optimal tissue sampling during ERCP and emerging molecular techniques for the differentiation of benign and malignant biliary strictures |
title_full | Optimal tissue sampling during ERCP and emerging molecular techniques for the differentiation of benign and malignant biliary strictures |
title_fullStr | Optimal tissue sampling during ERCP and emerging molecular techniques for the differentiation of benign and malignant biliary strictures |
title_full_unstemmed | Optimal tissue sampling during ERCP and emerging molecular techniques for the differentiation of benign and malignant biliary strictures |
title_short | Optimal tissue sampling during ERCP and emerging molecular techniques for the differentiation of benign and malignant biliary strictures |
title_sort | optimal tissue sampling during ercp and emerging molecular techniques for the differentiation of benign and malignant biliary strictures |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053835/ https://www.ncbi.nlm.nih.gov/pubmed/33948111 http://dx.doi.org/10.1177/17562848211002023 |
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