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Fluoroscopic percutaneous brush cytology, forceps biopsy and both in tandem for diagnosis of malignant biliary obstruction

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate percutaneous brush cytology, forceps biopsy and a tandem procedure consisting of both, in the diagnosis of malignant biliary obstruction.

Methods

A retrospective review of consecutive patients who underwent biliary brush cytology and/or forceps biopsy between 01/2010 and 09/2014 was performed. The cytology and pathology results were compared to the composite outcome (including radiological, pathological and clinical data). Cost for tandem procedure compared to brush cytology and forceps biopsy alone was calculated.

Results

A total of 232 interventions in 129 patients (70.8 ± 11.0 years) were included. Composite outcome showed malignancy in 94/129 (72.9%) patients. Sensitivity for brush cytology, forceps biopsy and tandem procedure was 40.6% (95% CI 32.6–48.7%), 42.7% (32.4–53.0%) and 55.8% (44.7–66.9%) with 100% specificity, respectively. There were 9/43 (20.9%) additional cancers diagnosed when forceps biopsy was performed in addition to brush cytology, while there were 13/43 (30.2%) more cancers diagnosed when brush cytology was performed in addition to forceps biopsy. Additional costs per additionally diagnosed malignancy if tandem approach is to be utilised in all cases was $704.96.

Conclusion

Using brush cytology and forceps biopsy in tandem improves sensitivity compared to brush cytology and forceps biopsy alone in the diagnosis of malignant biliary obstruction.

Key points

• Tandem procedure improves sensitivity compared to brush cytology and forceps biopsy.

• Brush cytology may help to overcome “crush artefacts” from forceps biopsy.

• The cost per diagnosed malignancy may warrant tandem procedure in all patients.

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Abbreviations

PTBD:

Percutaneous Transhepatic Biliary Drainage

IR:

Interventional Radiology

HJ:

Hepaticojenunal

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Authors and Affiliations

  1. Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Johannes Boos, Raphael J. Yoo, Jennifer Steinkeler, Gamze Ayata, Muneeb Ahmed, Ammar Sarwar, Jeffrey Weinstein, Salomao Faintuch & Olga R. Brook

  2. Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany

    Johannes Boos

Authors
  1. Johannes Boos
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  2. Raphael J. Yoo
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  3. Jennifer Steinkeler
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  4. Gamze Ayata
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  5. Muneeb Ahmed
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  6. Ammar Sarwar
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  7. Jeffrey Weinstein
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  8. Salomao Faintuch
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  9. Olga R. Brook
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Corresponding author

Correspondence to Olga R. Brook.

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Guarantor

The scientific guarantor of this publication is Olga R. Brook.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

One of the authors has significant statistical expertise (Alexander Brook).

Ethical approval

Institutional review board approval was obtained.

Informed consent

Written informed consent was waived by the institutional review board.

Study subjects or cohorts overlap

None of the study subjects or cohorts have been previously reported.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Appendix Table 1

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Appendix Table 2

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Boos, J., Yoo, R.J., Steinkeler, J. et al. Fluoroscopic percutaneous brush cytology, forceps biopsy and both in tandem for diagnosis of malignant biliary obstruction. Eur Radiol 28, 522–529 (2018). https://doi.org/10.1007/s00330-017-4987-5

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  • DOI: https://doi.org/10.1007/s00330-017-4987-5

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