Endoscopy 2018; 50(11): 1059-1070
DOI: 10.1055/a-0607-2534
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Reliability and accuracy of a novel classification system using peroral cholangioscopy for the diagnosis of bile duct lesions

Carlos Robles-Medranda
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
,
Manuel Valero
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
,
Miguel Soria-Alcivar
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
,
Miguel Puga-Tejada
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
,
Roberto Oleas
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
,
Jesenia Ospina-Arboleda
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
,
Haydee Alvarado-Escobar
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
,
Jorge Baquerizo-Burgos
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
,
Carlos Robles-Jara
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
,
Hannah Pitanga-Lukashok
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
› Author Affiliations
TRIAL REGISTRATION: single-center, observational, case-crossover, prospective Study NCT02794987 at clinicaltrials.gov
Further Information

Publication History

submitted 03 September 2017

accepted after revision 12 March 2018

Publication Date:
28 June 2018 (eFirst)

Abstract

Background The aim of this study was to propose a novel, comprehensive, macroscopic classification for bile duct lesions.

Methods A two-stage protocol was designed. In Stage I, a retrospective study (September 2013 to September 2015) of patients with bile duct lesions detected by peroral cholangioscopy (POCS) was performed. A total of 315 images with at least 6 months of follow-up were recorded, analyzed, and correlated to histology, and were classified as non-neoplastic (one of three types, 1 – 3) or neoplastic (one of four types, 1 – 4) based on morphological and vascular patterns. In Stage II, a prospective, nonrandomized, double-blind study was performed from December 2015 to December 2016 to validate the proposed classification. Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios (LR + and LR – , respectively) were calculated (gold standard: 6-month follow-up). Inter- and intraobserver agreement (kappa value, κ) among experts and non-experts were calculated.

Results 171 patients were included (65 retrospective; 106 prospective). In Stage I, 28/65 cases were neoplastic and 37 /65 were non-neoplastic, according to the final diagnosis. In Stage II, 56/106 were neoplastic with a sensitivity, specificity, PPV, NPV, LR + , and LR – for neoplastic diagnosis of 96.3 %, 92.3 %, 92.9 %, 96 %, 12.52, and 0.04, respectively. The proposed classification presented high reproducibility among observers, for both neoplastic and subtypes categories. However, it was better for experts (κ > 80 %) than non-experts (κ 64.7 % – 81.9 %).

Conclusion The novel classification system could help physicians to distinguish non-neoplastic from neoplastic bile duct lesions.