Vascular and Interventional Radiology

Bile Duct: Analysis of Percutaneous Transluminal Forceps Biopsy in 130 Patients Suspected of Having Malignant Biliary Obstruction

Abstract

PURPOSE: To evaluate percutaneous transluminal forceps biopsy in patients suspected of having a malignant biliary obstruction.

MATERIALS AND METHODS: One hundred thirty consecutive patients (82 men and 48 women; mean age, 59 years) with obstructive jaundice underwent transluminal forceps biopsy during or after percutaneous transhepatic biliary drainage. The lesions involved the common bile duct (n = 58), common hepatic duct (n = 39), hilum (n = 14), ampullary segment of the common bile duct (n = 11), right or left intrahepatic bile duct (n = 5), or the entire extrahepatic bile duct (n = 3). In each patient, three to five specimens (mean, 4.1 specimens) were taken from the lesion with 5.4-F biopsy forceps. The final diagnosis for each patient was confirmed with pathologic findings at surgery, additional histocytologic data, or clinical and radiologic follow-up. Statistical analysis was performed with the χ² test; a P value ≤ .05 was considered to indicate a significant difference.

RESULTS: Ninety-eight of 130 biopsies resulted in correct diagnoses of malignancy. Five biopsy diagnoses proved to be true-negative. There were 27 false-negative diagnoses and no false-positive diagnoses. The diagnostic performance of transluminal forceps biopsy in malignant biliary obstructions was as follows: sensitivity, 78.4%; specificity, 100%; and accuracy, 79.2%. Sensitivity of biopsy in the 82 patients with cholangiocarcinoma was higher than in the 43 patients with malignant tumors other than cholangiocarcinoma (86.6% vs 62.8%, P < .005). Sensitivity was significantly lower in the ampullary segment of the common bile duct than in other sites (P < .01). No major complications related to the biopsy procedures occurred.

CONCLUSION: Percutaneous transluminal forceps biopsy is a safe procedure that is easy to perform through a transhepatic biliary drainage tract. It provides relatively high accuracy in the diagnosis of malignant biliary obstructions.

References

1 Droese M, Altmannsberg M, Kehl A, et al. Ultrasound-guided percutaneous fine-needle aspiration biopsy of abdominal and retroperitoneal masses. Acta Cytol 1984; 28: 368-384. Medline, Google Scholar
2 Welch TJ, Sheedy PF, II, Johnson CD, Johnson CM, Stephens DH. CT-guided biopsy: prospective analysis of 1000 procedures. Radiology 1989; 171: 493-496. Link, Google Scholar
3 Silverman SG, Deuson TE, Kane N, et al. Percutaneous abdominal biopsy: cost-identification analysis. Radiology 1998; 206: 429-435. Link, Google Scholar
4 Hopper KD, Abendroth CS, Sturtz KW, Matthews YL, Shirk SJ, Stevens LA. Blinded comparison of biopsy needles and automated devices in vitro. II. Biopsy of medical renal disease. AJR Am J Roentgenol 1993; 161: 1299-1301. Google Scholar
5 Burbank F, Kaye K, Belville J, Ekuan J, Blumenfeld M. Image-guided automated core biopsies of the breast, chest, abdomen, and pelvis. Radiology 1994; 191: 165-171. Link, Google Scholar
6 Baron RL, Stanley RJ, Lee JK, et al. A prospective comparison of the evaluation of biliary obstruction using computed tomography and ultrasonography. Radiology 1982; 145: 91-98. Link, Google Scholar
7 Hall-Craggs MA, Lees WR. Fine-needle aspiration biopsy: pancreatic and biliary tumors. AJR Am J Roentgenol 1986; 147: 399-403. Crossref, Medline, Google Scholar
8 Chitwood WR, Jr, Meyers WC, Heaston DK, Herskovic AM, McLeod ME, Jones RS. Diagnosis and treatment of primary extrahepatic bile duct tumors. Am J Surg 1982; 143: 99-106. Crossref, Medline, Google Scholar
9 Evander A, Fredlund P, Hoevels J, Ihse I, Bengmark S. Evaluation of aggressive surgery for carcinoma of the extrahepatic bile ducts. Ann Surg 1980; 191: 23-29. Crossref, Medline, Google Scholar
10 Elyaderani MK, Gabriele OF. Brush and forceps biopsy of biliary ducts via percutaneous transhepatic catheterization. Radiology 1980; 135: 777-778. Link, Google Scholar
11 Terasaki K, Wittich GR, Lycke G, et al. Percutaneous transluminal biopsy of biliary strictures with a bioptome. AJR Am J Roentgenol 1991; 156: 77-78. Crossref, Medline, Google Scholar
12 Kim CS, Han YM, Song HY, Choi KC, Kim DG, Cho BH. Percutaneous transhepatic biliary biopsy using gastrofiberscopic biopsy forceps. J Korean Med Sci 1992; 7: 325-332. Crossref, Medline, Google Scholar
13 Donald JJ, Fache JS, Burhenne HJ. Percutaneous transluminal biopsy of the biliary tract. Can Assoc Radiol J 1993; 44: 185-188. Medline, Google Scholar
14 Tsai CC, Mo LR, Chou CY, et al. Percutaneous transhepatic transluminal forceps biopsy in obstructive jaundice. Hepatogastroenterology 1997; 44: 770-773. Medline, Google Scholar
15 Savader SJ, Prescott CA, Lund GB, Osterman FA. Intraductal biliary biopsy: comparison of three techniques. J Vasc Interv Radiol 1996; 7: 743-750. Crossref, Medline, Google Scholar
16 Gunther RW, Schild H, Thelen M. Percutaneous transhepatic biliary drainage: experience with 311 procedures. Cardiovasc Intervent Radiol 1988; 11: 65-71. Crossref, Medline, Google Scholar
17 Savader SJ, Lynch FC, Radvany MG, et al. Single-specimen bile cytology: a prospective study of 80 patients with obstructive jaundice. J Vasc Interv Radiol 1998; 9: 817-821. Crossref, Medline, Google Scholar
18 Ryan ME. Cytologic brushings of ductal lesions during ERCP. Gastrointest Endosc 1991; 37: 139-142. Crossref, Medline, Google Scholar
19 Cropper LD, Jr, Gold RE. Simplified brush biopsy of the bile ducts. Radiology 1983; 148: 307-308. Link, Google Scholar
20 Mendez G, Jr, Russel E, Levi JU, Koolpe H, Cohen M. Percutaneous brush biopsy and internal drainage of biliary tree through endoprosthesis. AJR Am J Roentgenol 1980; 134: 653-659. Crossref, Medline, Google Scholar
21 Kim D, Porter DH, Siegel JB, Mowschenson PM, Steer ML. Common bile duct biopsy with the Simpson atherectomy catheter. AJR Am J Roentgenol 1990; 154: 1213-1215. Crossref, Medline, Google Scholar
22 Schechter MS, Doemeny JM, Johnson JO. Biliary ductal shave biopsy with use of the Simpson atherectomy catheter. J Vasc Interv Radiol 1993; 4: 819-824. Crossref, Medline, Google Scholar
23 Nimura Y. Staging of biliary carcinoma: cholangiography and cholangioscopy. Endoscopy 1993; 25: 76-80. Crossref, Medline, Google Scholar
24 Thomas JH, Pierce GE, Karlin C, Hermreck AS, MacArthur RI. Extrahepatic biliary obstruction secondary to metastatic cancer. Am J Surg 1981; 142: 770-773. Crossref, Medline, Google Scholar
25 Lee BH, Chin SY, Kim SA, Kim KH, Do YS. Obstructive jaundice in gastric carcinoma: cause, site, and relationship to the primary lesion. Abdom Imaging 1995; 20: 307-311. Crossref, Medline, Google Scholar
26 Sato M, Inoue H, Ogawa S, et al. Limitations of percutaneous transhepatic cholangioscopy for the diagnosis of the intramural extension of bile duct carcinoma. Endoscopy 1998; 30: 281-288. Crossref, Medline, Google Scholar
27 Cohan RH, Illescas FF, Braun SD, Newman GE, Dunnick NR. Fine needle aspiration biopsy in malignant obstructive jaundice. Gastrointest Radiol 1986; 11: 145-150. Crossref, Medline, Google Scholar
28 Yamaguchi K, Enjoji M, Nakayama F. Cancer of the extrahepatic bile duct: a clinicopathologic study of immunohistochemistry for CEA, CA19-9, and p21. World J Surg 1988; 12: 11-17. Crossref, Medline, Google Scholar
29 Ponchon T, Gagnon P, Berger F, et al. Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. Gastrointest Endosc 1995; 42: 565-572. Crossref, Medline, Google Scholar

Article History

Published in print: Sept 2002

Vol. 224, No. 3

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