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Systematic review and meta-analysis of percutaneous transluminal forceps biopsy for diagnosing malignant biliary strictures

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To perform a systematic review and meta-analysis to determine the diagnostic performance of percutaneous transluminal forceps biopsy (PTFB) for differentiating malignant from benign biliary stricture.

Methods

A comprehensive literature search of the PubMed, EMBASE, and Ovid MEDLINE databases was conducted to identify original articles published between January 2001 and January 2021 reporting the diagnostic accuracy of PTFB. A random-effects model was used to summarize the diagnostic odds ratio and other measures of accuracy.

Results

Fourteen studies involving 1762 patients met the inclusion criteria and were included in the meta-analysis. The meta-analysis summary estimates of PTFB for diagnosis of malignant biliary strictures were as follows: sensitivity 81% (95% confidence interval [CI], 78–81%); specificity 100% (95% CI, 98–100%); diagnostic odds ratio 85.34 (95% CI, 38.37–189.81). The area under the curve of PTFB was 0.948 in the diagnosis of malignant biliary strictures. The diagnostic sensitivity was higher in intrinsic (85%) than in extrinsic (73%) biliary strictures. The pooled rate of all complications was 10.3% (95% CI, 7.0–14.2%), including a major complication rate of 3.1%.

Conclusion

These data demonstrate that PTFB is sensitive and highly specific for diagnosing malignancy in biliary strictures. PTFB should be incorporated into future guidelines for tissue sampling in biliary cancer, especially in cases with failed endoscopic management.

Key Points

• PTFB had a good overall diagnostic performance for differentiating malignant from benign biliary strictures, with a meta-analysis summary estimate of 81% for sensitivity and 100% for specificity.

• PTFB had higher sensitivity for cholangiocarcinoma (85%) than for other cancers (73%).

• PTFB had a 100% technical success rate and a 10.3% rate for complications, including a 3.1% rate for major complications.

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Abbreviations

AUC:

Areas under the curve

CCA:

Cholangiocarcinoma

CI:

Confidence interval

CT:

Computed tomography

DOR:

Diagnostic odds ratio

ERCP:

Endoscopic retrograde cholangiopancreatography

EUS:

Endoscopic ultrasonography

NLR:

Negative likelihood ratio

PLR:

Positive likelihood ratio

PTBD:

Percutaneous transhepatic biliary drainage

PTFB:

Percutaneous transluminal forceps biopsy

SROC:

Summary receiver operating characteristics

US:

Ultrasonography

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Funding

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

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Author notes

  1. Tae Yeon Jeon and Moon Hyung Choi contributed equally to this work as first authors.

  2. Seung Bae Yoon and Sung-Hoon Moon contributed equally to this work as corresponding authors.

Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Tae Yeon Jeon

  2. Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Moon Hyung Choi

  3. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea

    Seung Bae Yoon

  4. Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, South Korea

    Jae Seung Soh & Sung-Hoon Moon

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Correspondence to Seung Bae Yoon or Sung-Hoon Moon.

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The scientific guarantor of this publication is Sung-Hoon Moon.

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.

Statistics and biometry

One of the authors (Seung Bae Yoon) has significant statistical expertise.

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Written informed consent was not required for this study because this study was a systematic review and meta-analysis.

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Institutional review board approval was not required because this study was a systematic review and meta-analysis.

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Jeon, T.Y., Choi, M.H., Yoon, S.B. et al. Systematic review and meta-analysis of percutaneous transluminal forceps biopsy for diagnosing malignant biliary strictures. Eur Radiol 32, 1747–1756 (2022). https://doi.org/10.1007/s00330-021-08301-1

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  • DOI: https://doi.org/10.1007/s00330-021-08301-1

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