Routinely used diagnostic approaches: only limited diagnostic sensitivity for bile duct cancer?

Surgery is the only curative treatment in patients with bile duct cancer.

To develop a therapeutic concept a reliable diagnostic procedure is of great importance in these patients. Due to longitudinal tumor growth along the bile duct, imaging techniques including ultrasound, computed tomography, and magnetic resonance imaging are of limited sensitivity for the detection of bile duct cancer. Brush cytology and/or forceps biopsy during endoscopy are routinely used for distinction between benign bile duct stricture and bile duct cancer. The current study was designed to address the question of diagnostic sensitivity for brush cytology and forceps biopsy in a homogeneous patient group with bile duct cancer.

This research, performed by a team led by Prof. Dr. Christian Prinz and his colleagues, is described in a research article to be published in the February 21, 2008 issue of the World Journal of Gastroenterology.

In 41.4% of patients, positive results for malignancy were obtained using brush cytology and in 53.4% of patients positive results were obtained using forceps biopsy. The combination of both techniques resulted in only a minor increase in diagnostic sensitivity¡ªup to 60.3%. Overall, in 23 out of 58 patients, definitive diagnosis could not be achieved using the combination of brush cytology and forceps biopsy.

In the view of the authors the results for routinely used diagnostic approaches in patients with bile duct cancer are disappointing. Therefore, additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings.

Further research should clarify diagnostic utility of new diagnostic approaches such as modern molecular markers for bile duct cancer.