Tissue sampling in biliary tract cancer (BTC) is generally performed through transpapillary biopsy (TPB) or endoscopic ultrasound-guided tissue acquisition (EUS-TA). For the first time, we compared the suitability of specimens obtained using TPB and EUS-TA to determine the optimal tissue-sampling method for comprehensive genome profiling (CGP) analysis in patients with unresectable BTC (UR-BTC). Pathology precheck criteria for CGP analysis comprised the OncoGuide NCC Oncopanel System (NCCOP) and FoundationOne CDx (F1CDx). Seventy-eight patients with UR-BTC (35 TPB and 43 EUS-TA) were included. The NCCOP analysis suitability achievement rate was higher in EUS-TA specimens than in TPB specimens (34.9% vs. 8.6%,p= 0.007), whereas that of F1CDx was 0% in both groups. EUS-TA was identified as an independent factor that contributed to the suitability of the NCCOP analysis. The suitability of the NCCOP analysis of EUS-TA specimens showed a tendency to be higher for mass lesions (43.8% vs. 9.1%,p= 0.065), especially for target size ≥ 18.5 mm, and lower for perihilar cholangiocarcinoma (0% vs. 41.7%,p= 0.077). In TPB, papillary-type lesions (66.7% vs. 3.2%,p= 0.016) and peroral cholangioscopy-assisted biopsies (50.0% vs. 3.3%,p= 0.029) showed better potential for successful NCCOP analysis. EUS-TA is suitable for NCCOP analysis in UR-BTC and may be partially complemented by TPB.
胆道癌（BTC）的组织采样通常通过经乳头活检（TPB）或内镜超声引导下组织获取（EUS-TA）进行。本研究首次比较了TPB与EUS-TA获取标本的适用性，以确定不可切除胆道癌（UR-BTC）患者进行全面基因组分析（CGP）的最佳组织采样方法。CGP分析的病理预检标准基于OncoGuide NCC Oncopanel系统（NCCOP）和FoundationOne CDx（F1CDx）。研究纳入78例UR-BTC患者（35例TPB，43例EUS-TA）。EUS-TA标本的NCCOP分析适用率显著高于TPB标本（34.9% vs. 8.6%，p=0.007），而两组F1CDx适用率均为0%。EUS-TA被确定为影响NCCOP分析适用性的独立因素。在EUS-TA标本中，肿块型病变的NCCOP分析适用率呈现更高趋势（43.8% vs. 9.1%，p=0.065），尤其当靶病灶尺寸≥18.5 mm时更明显；而肝门部胆管癌的适用率较低（0% vs. 41.7%，p=0.077）。在TPB采样中，乳头型病变（66.7% vs. 3.2%，p=0.016）和经口胆道镜辅助活检（50.0% vs. 3.3%，p=0.029）显示出更高的NCCOP分析成功潜力。研究表明，EUS-TA适用于UR-BTC的NCCOP分析，而TPB可在特定情况下作为补充手段。
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