Diagnostic accuracy of simpson atherectomy catheter biopsy in detecting pancreaticobiliary malignancy

OBJECTIVE

Impressive advances have been made in imaging the biliary tree by various modalities in the last few decades. However, the histological diagnosis of stenosing lesions in the biliary ductal system has remained difficult and unreliable. Application of Simpson atherectomy catheter biopsy in obtaining accurate histological diagnosis of bile duct lesions appears promising. The purpose of our study was to determine the clinical accuracy of the Simpson atherectomy catheter biopsy in the evaluation of bile duct strictures.

METHODS

A retrospective study of medical records of patients who underwent bile duct biopsy by atherectomy catheter was conducted between 1991 and 1999. During this period, 53 patients underwent 56 endoluminal bile duct biopsies with an atherectomy catheter as part of an obstructive jaundice workup. Histological diagnosis on biopsy was confirmed by subsequent surgical biopsy and/or clinical follow-up.

RESULTS

Fifty-four (96%) bile duct biopsies were technically successful in terms of yielding a histological diagnosis. Thirty-one of the 56 (55%) biopsy specimens were positive for malignancy (27 adenocarcinoma, two islet cell-carcinoids, one small cell carcinoma, and one malignant lymphoma). Four (7%) were read by the pathologist as highly suspicious for malignancy, and 19 (34%) specimens were considered negative for malignancy. Sensitivity of atherectomy catheter endoluminal biliary biopsy in this study was 97% with a specificity of 100%. In addition, the positive predictive and negative predictive values of this modality were 100% and 93%, respectively.

CONCLUSIONS

Endoluminal bile duct biopsy by Simpson atherectomy catheter appears to be a highly sensitive and specific method for establishing histological diagnosis of stenosing lesions in the biliary ductal system.

Evaluation of palliative resection in advanced carcinoma of the stomach

A retrospective study of 140 patients with adenocarcinoma of the stomach seen at Roswell Park Memorial Institute during a 5 year period revealed that 112 patients were TNM Stages III or IV. A palliative resection of the stomach was done in 39 patients; the other 73 did not undergo resection. Patients who had palliative resection for stages III and IV carcinoma of the stomach had a prolonged mean survival rate, as compared with those with similar stage of disease who did not have palliative resection, regardless of an additional treatment such as feeding procedures, gastroenterostomy, chemotherapy, and radiation therapy. This significance was noticed regardless of age, sex, and histological differentiation of the tumor. Chemotherapy significantly increased the survival rate in the unresected group but failed to show this effect in the resected group.