965 SENSITIVITY AND SPECIFICITY OF ALPHA-FETO PROTEIN (AFP), LENS CULINARIS AGGLUTININ-REACTIVE AFP (AFP-L3) AND DES- GAMMA-CARBOXYPROTHROMBIN (DCP) AS TUMOR MARKERS IN PATIENTS WITH HEPATOCELLULAR CARCINOMA (HCC)

POSTERSretrograde cholangiopancretography (ERCP), but lacks sensitivity for cancer detection (18%-60%).We assessed a novel tissue-sampling method for cancer detection at ERCP in a pilot study.Aims and methods: 35 consecutive patients with suspected malignant pancreatobiliary strictures were prospectively studied through tissue sampling at ERCP.All patients signed an informed consent.For each patient we performed standard brushing of the stricture.After that, we modified a second catheter by removing the brush, and moved the tip back and forth within the stricture at least 10 times, aspirating fluid through a specimen trap connected to a suction line.We called this novel manipulation of the stricture IntraDuctal Aspiration (IDA).Intraductally aspirated fluids were evaluated by two experienced cytopathologists.A definitive diagnosis was obtained at the end of the follow-up.Our aims were to compare feasibility, sample adequacy, accuracy, sensitivity and specificity, positive and negative predictive value (PPV, NPV), and safety of IDA versus standard brushing.Results: Twenty-two male/13 female, mean age 61±20, underwent ERCP for suspected malignant pancreatobiliary stricture.Thirtytwo had biliary stricture and three had pancreatic stricure.Both techniques were successfully applied to each stricture.Our cytopathologists judged IDA sample adequacy significantly superior to brushing (p < 0.001).Diagnostic accuracy was 97% and 88% for IDA and brushing, respectively.The sensitivity and specificity for cancer detection were 92% (95% CI 60-100%) and 100% (95% CI 80-100%) for IDA, and 67% (95% CI 12-98%) and 100% (95% CI 42-100%) for brushing.PPV and NPV were 100% (95% CI 68-100%) and 95% (95% CI 74-100%) for IDA, and 100% (95% CI 20-100%) and 83% (95% CI 36-99%) for brushing.There were no adverse events.Conclusions: We found this novel tissue sampling technique (IDA) to be feasible and safe.IDA sample adequacy for cytodiagnosis was superior to standard brushing, with a higher rate of accuracy, sensitivity and NPV.These preliminary data appear to suggest that IDA may represent a new gold-standard for cytodiagnosis at ERCP.Further studies of larger numbers of patients will be necessary to confirm these findings.