WHAT TO CHOOSE WHEN DIAGNOSING EXTRAHEPATIC BILE DUCT TUMORS: EUS-FNA OR CONTRAST ENHANCED EUS-FNA.

Aims. Contrast enhanced endoscopic ultrasound (CH-EUS) is superior to standard endoscopic ultrasound (EUS) for T staging of biliary duct tumors (BDT) but its role in guiding EUS-fine needle aspiration (EUS-FNA) is unknown. We compared the diagnostic performance of CH-EUS-fine needle aspiration (CH-EUS-FNA) and standard EUS-FNA in BTD and aimed to determine the factors influencing the Results. Methods. This randomized controlled study was conducted in a tertiary medical center and included jaundiced patients with BDT on CT scan. Patients were randomly assigned to EUS-FNA or to CH-EUSFNA group. Final diagnosis was based either on EUSFNA or surgical specimen results or endoscopic retrograde cholangiopancreatography (ERCP) or 12-month follow-up. Results. 61 patients were included in the study, 31 in EUS-FNA and 30 in CH-EUS-FNA group (mean age 74±11.04 years, mean tumor dimension 20.39±9.17mm). Most BDT were located in the distal bile duct (n= 40). Final diagnosis (based on: surgery in 9 cases, ERCP in 7, EUS-FNA in 41, follow-up in 4) were: cholangiocarcinoma (n=37), pancreatic ductal carcinoma (n=12), other malignancy (n=3), benign lesion (n=9). Diagnostic sensitivity, specificity and accuracy were 84%, 100% and 87% respectively in EUS-FNA and 82%, 100%, and 83% respectively in CH-EUS-FNA group (p=0.22). Plastic biliary stent placement or tumor location did not influence the results CH-EUS hyperenhancement with rapid washout was seen in 81.8% of cholangiocarcinoma cases. Conclusions. Most but not all of cholangiocarcinoma are hyperenhanced, but CHEUS-FNA had similar value with standard EUS-FNA in diagnosing bile duct tumors. [ABSTRACT FROM AUTHOR]