E-ISSN: 1305-3612
Percutaneous endobiliary forceps biopsy of biliary strictures for histopathologic examination
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Interventional Radiology - Original Article
VOLUME: 26 ISSUE: 4
P: 339-344
July 2020

Percutaneous endobiliary forceps biopsy of biliary strictures for histopathologic examination

Diagn Interv Radiol 2020;26(4):339-344
DOI: 10.5152/dir.2020.19329
Anne Marie Augustin 1
Marcus Steingrüber 1
Friederika Fluck 1
Oliver Goetze 2
Thorsten Alexander Bley 1
Ralph Kickuth 1
1. Department of Diagnostic and Interventional Radiology, University-Hospital of Würzburg, Würzburg, Germany
2. Department of Internal Medicine II, Division of Hepatology, University-Hospital of Würzburg, Würzburg, Germany
No information available.
No information available
Received Date: 27.05.2019
Accepted Date: 15.05.2020
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ABSTRACT

PURPOSE

We aimed to investigate the feasibility, accuracy and safety of percutaneous endobiliary cholangio-forceps biopsy of biliary strictures in our institution.

METHODS

A total of 13 percutaneous transhepatic endobiliary biopsies (7 men and 6 women, mean age 66.85±16.76 years) were performed between January 2015 and March 2019 using a transluminal forceps biopsy device. Technical success, rate of complications, number of biopsy specimens, procedure and fluoroscopy time, mean radiation exposure were evaluated; sensitivity and accuracy were calculated.

RESULTS

Technical success, i.e., acquisition of at least three (median, 3.00; range, 3–5) macroscopic representative samples, could be achieved in all 13 biopsies. Access was gained via the right liver lobe in 12 of 13 cases (92.3%). All patients presented blood work indicative of cholestasis prior the intervention, with mean bilirubin 4.72±3.72 µmol/L, mean γ-glutamyl transferase 574.16 ± 360.92 IU/L, and median alkaline phosphatase 407 IU/L (165–1366 IU/L). In 12 of 13 cases (92.3%), biopsied material was sufficient for the pathologist to make a histopathologic diagnosis. Analysis revealed cases of malignancy in eight of 13 cases (61.5%), all of which turned out to be cases of cholangiocarcinoma. In four benign cases (30.8%), diagnosis was considered to be confirmed by further imaging or clinical follow-ups, which showed no signs of progressive disease. There was one case (7.7%) of a false-negative result with proof of malignancy in subsequent surgical tissue extraction. A calculation of diagnostic performance yielded a sensitivity rate of 88.9% and an accuracy rate of 92.3%. There was one case of minor and one case of major complication in our study collective, leading to an overall complication rate of 15.4%.

CONCLUSION

Percutaneous transhepatic biliary drainage (PTBD)-based forceps biopsy via the transhepatic drainage tract in patients with biliary obstruction of unknown origin is a technically feasible and safe technique with good diagnostic value rates. The procedure should be considered in patients not suitable for endoscopic strategies with indication for establishment of PTBD.