Abnormal Vasculature May Distinguish Neoplastic Bile Duct Lesions on Digital Single-Operator Cholangioscopy

Can detection of irregular or spider vascularity on bile duct lesions during DSOC evaluations identify biliary neoplastic lesions? A new study examines this question.

Irregular vasculature on bile duct lesions detected during digital single-operator cholangioscopy (DSOC) may be able to distinguish neoplastic from nonneoplastic lesions, according to study data published in Gastrointestinal Endoscopy.  

This retrospective cohort study extracted data from the medical and endoscopic records of patients who underwent DSOC between January 2017 and May 2018 at a tertiary center in Ecuador. Neovasculature was defined as the presence of irregular or spider vascularity on bile duct lesions. Researchers determined the presence of neoplasia using histologic and follow-up data. Among patients with abnormal biopsy findings, clinical follow-up and endoscopic retrograde cholangiopancreatography with DSOC were performed at 6 months. Among patients with negative biopsy results, only clinical follow-up was conducted. A set of 30 DSOC images of neoplastic and nonneoplastic biliary lesions were presented to 2 expert endoscopists and 3 physicians without experience in DSOC. Observers were asked to diagnose lesions as neoplastic or nonneoplastic, depending on vasculature. Observers were blinded to patient medical records, follow-up results, and histology outcomes. The ability of neovasculature to distinguish neoplasia from nonneoplasia was evaluated as a function of accuracy, sensitivity, and specificity. Intraobserver and interobserver agreement were determined using Cohen and Fleiss kappa (ᴋ) values, respectively.

The study cohort comprised 95 patients, among whom 51 (53.7%) were women. Median age was 65.6 (range, 20-93) years. DSOC was successfully completed in 100% of patients. A total of 52 patients were diagnosed with neoplasia using a combination of histology results and follow-up outcomes. “Irregular, tortuous vessels” were observed in 49 of 52 (94.2%) neoplastic lesions and 16 of 43 (37.2%) nonneoplastic lesions. Neovascularity identified neoplastic lesions with an accuracy of 80%, a sensitivity of 94%, and a specificity of 63%. Positive predictive value and negative predictive value were 75% and 90%, respectively. Interobserver and intraobserver agreement were excellent between the 2 endoscopists (both ᴋ values >80%; P <.001). Among the 3 physicians, interobserver (Fleiss ᴋ=86.4%; P <.001) and intraobserver (Cohen ᴋ>80%; P <.001) were also excellent. DSOC-guided biopsy identified neoplasia in 48 (50.5%) patients. DSOC-guided biopsy had an accuracy of 94%, a sensitivity of 90%, and a specificity of 100% for the detection of neoplastic biliary structures.

These data suggest that DSOC-detected neovasculature may be a diagnostic indicator of neoplasia. As study limitations, investigators cited the retrospective design and relatively small cohort size. Prospective research at multiple centers is necessary to confirm these findings.

“Although currently considered a complementary examination in patients with indeterminate biliary stricture, DSOC could become a first-line approach in this clinical scenario with new, defined visualization criteria and advances in optic resolution,” investigators wrote.

Disclosure: One study author declared affiliations with the pharmaceutical industry.

Please see the original reference for a full list of authors’ disclosures.

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Robles-Medranda C, Oleas R, Sánchez-Carriel M, et al. Vascularity can distinguish neoplastic from non-neoplastic bile duct lesions during digital single-operator cholangioscopy [published online July 21, 2020]. Gastrointest Endosc. doi: 10.1016/j.gie.2020.07.025