Optimal tissue sampling during ERCP and emerging molecular techniques for the differentiation of benign and malignant biliary strictures
| Autor: | Eline J. C. A. Kamp, Annemarie C. de Vries, Pieter J F de Jonge, Michail Doukas, Maikel P. Peppelenbosch, Winand N.M. Dinjens, Marco J. Bruno |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
RC799-869 Review medicine.disease_cause chromosomal imbalance SDG 3 - Good Health and Well-being CDKN2A GNAS complex locus Medicine Sampling (medicine) Stage (cooking) Endoscopic retrograde cholangiopancreatography biology medicine.diagnostic_test epigenetics business.industry Bile duct Gastroenterology Diseases of the digestive system. Gastroenterology medicine.anatomical_structure immunohistochemistry biology.protein next-generation sequencing Radiology KRAS mutation business Fluorescence in situ hybridization |
| Zdroj: | Therapeutic Advances in Gastroenterology Therapeutic Advances in Gastroenterology, Vol 14 (2021) |
| ISSN: | 1756-283X |
| DOI: | 10.1177/17562848211002023 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|