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Transhepatic forceps biopsy combined with biliary drainage in obstructive jaundice: safety and accuracy

  • Audrey Fohlen
  • Celine Bazille
  • Benjamin Menahem
  • Marc Antoine Jegonday
  • Benoit Dupont
  • Vincent Le Pennec
  • Jean Lubrano
  • Boris Guiu
  • Jean Pierre Pelage
Hepatobiliary-Pancreas
  • 18 Downloads

Abstract

Purpose

This study was conducted in order to investigate the safety and accuracy of percutaneous transluminal forceps biopsy (PTFB) during percutaneous biliary drainage (PTBD) in patients with a suspicion of malignant biliary stricture.

Material and methods

Fifty consecutive patients with obstructive jaundice underwent PTFB during PTBD. Biopsy specimens were obtained using 5.2-F flexible biopsy forceps and these specimens were independently analysed by two pathologists. Consensus was obtained in case of discrepancy. Biopsy was considered as a true positive when tumour cells were retrieved. In the absence of tumour cells, comparison with available surgical findings and/or endoscopic ultrasound fine-needle aspiration (EUS-FNA) and/or percutaneous liver biopsy and/or imaging or clinical follow-up was made to distinguish true and false negatives. Specificity, sensitivity, positive predictive value, negative predictive value and accuracy were calculated. Influence of tumour location and pre-operative imaging findings was evaluated. Adverse events were reported.

Results

Biliary drainage and tissue sampling were achieved in 100% of patients. Sensitivity and specificity were 70 and 100%, respectively, while overall accuracy was 72%. After excluding the first 25 patients, accuracy and sensitivity for tissue sampling reached 80 and 78%, respectively. Sensitivity was better (87%) if stenosis was located at the upper part of the biliary tree, compared to the lower part (55%). In case of cholangiocarcinoma or intraductal invasion suspected on imaging, biopsy was contributive in 84 and 81% of patients, respectively. Four complications occurred consisting of one bile leak, two haemobilia and one pneumoperitoneum.

Conclusion

PTFB combined with PTBD is a safe and effective technique for both histopathological diagnosis and biliary decompression of biliary strictures.

Key Points

Implications for patient care:

• Percutaneous transbiliary forceps biopsy is technically feasible (100% of tissue sampling in our study) and is a safe technique.

• Radiological management combining PTFB plus PTBD may allow diagnosis and treatment of the biliary stricture at the same time.

• Sensitivity and accuracy for PTFB reached 78 and 80%, respectively, with a 100% specificity.

Keywords

Bile Obstructive jaundice Drainage Biopsy Bile duct neoplasms 

Abbreviations

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

CDHP

Cystic dystrophy in heterotopic pancreas

CE-CT

Contrast-enhanced computed tomography

CI

Confidence interval

CRP

C-reactive protein

CT

Computed tomography

DAP

Dose area product

ERCP

Endoscopic retrograde cholangiopancreatography

EUS-FNA

Endoscopic ultrasound-guided fine-needle aspiration

GGT

Gamma-glutamyltransferase

H&E

Haematoxylin and eosin

IBS

Indeterminate biliary stricture

MRI

Magnetic resonance imaging

NPV

Negative predictive value

PPV

Positive predictive value

PTBD

Percutaneous biliary drainage

PTFB

Percutaneous transhepatic forceps biopsy

SD

Skin dose

SIR

Society of Interventional Radiology

Notes

Funding

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

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Jean Pierre Pelage.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because it was a retrospective study, based on acquired data.

Ethical approval

Institutional Review Board approval was obtained.

CPP Nord Ouest-France, reference: CPP A15-D30-VOL.26.

Methodology

• Retrospective

• Observational

• Performed at one institution

Supplementary material

330_2018_5852_MOESM1_ESM.docx (23 kb)
ESM 1 (DOCX 23 kb)

References

  1. 1.
    Katabathina VS, Dasyam AK, Dasyam N, Hosseinzadeh K (2014) Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics 34:565–586CrossRefPubMedGoogle Scholar
  2. 2.
    Arrivé L, Hodoul M, Arbache A, Slavikova-Boucher L, Menu Y, El Mouhadi S (2015) Magnetic resonance cholangiography: current and future perspectives. Clin Res Hepatol Gastroenterol 39:659–664CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Singh A, Gelrud A, Agarwal B (2014) Biliary strictures: diagnostic considerations and approach. Gastroenterol Rep (Oxf) 3:22–31CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Tabibian JH, Visrodia KH, Levy MJ, Gostout CJ (2015) Advanced endoscopic imaging of indeterminate biliary strictures. World J Gastrointest Endosc 7:1268–1278CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Tringali A, Lemmers A, Meves V et al (2015) Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review. Endoscopy 47:739–753CrossRefPubMedGoogle Scholar
  6. 6.
    de Bellis M, Sherman S, Fogel EL et al (2002) Tissue sampling at ERCP in suspected malignant biliary strictures (part 2). Gastrointest Endosc 56:720–730CrossRefPubMedGoogle Scholar
  7. 7.
    Rösch T, Hofrichter K, Frimberger E et al (2004) ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc 60:390–396CrossRefPubMedGoogle Scholar
  8. 8.
    Weilert F, Bhat YM, Binmoeller KF et al (2014) EUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction: results of a prospective, single-blind, comparative study. Gastrointest Endosc 80:97–104CrossRefPubMedGoogle Scholar
  9. 9.
    De Moura DTH, Moura EGH, Bernardo WM et al (2016) Endoscopic retrograde cholangiopancreatography versus endoscopic ultrasound for tissue diagnosis of malignant biliary stricture: systematic review and meta-analysis. Endosc Ultrasound 7:10–19CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Lin M, Hair CD, Green LK et al (2014) Endoscopic ultrasound-guided fine-needle aspiration with on-site cytopathology versus core biopsy: a comparison of both techniques performed at the same endoscopic session. Endosc Int Open 2:220–223CrossRefGoogle Scholar
  11. 11.
    Elyaderani MK, Gabriele OF (1980) Brush and forceps biopsy of biliary ducts via percutaneous transhepatic catheterization. Radiology 135:777–778CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Jung GS, Huh JD, Lee SU, Han BH, Chang HK, Cho YD (2002) Bile duct: analysis of percutaneous transluminal forceps biopsy in 130 patients. Radiology 7:725–730CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Omary RA, Bettmann MA, Cardella JF et al (2003) Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol 14:S293–S295CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF (2010) Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 21:789–795CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ierardi AM, Mangini M, Fontana F et al (2013) Usefulness and safety of biliary percutaneous transluminal forceps biopsy (PTFB): our experience. Minim Invasive Ther Allied Technol 3:1–6Google Scholar
  16. 16.
    Li TF, Ren KW, Han XW (2014) Percutaneous transhepatic cholangiobiopsy to determine the pathological cause of anastomotic stenosis after cholangiojejunostomy for malignant obstructive jaundice. Clin Radiol 69:13–17CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Patel P, Rangarajan B, Mangat K (2015) Improved accuracy of percutaneous biopsy using “cross and push” technique for patients suspected with malignant biliary strictures. Cardiovasc Intervent Radiol 38:1005–1010CrossRefGoogle Scholar
  18. 18.
    Brown DB, Nikolic B, Covey AM et al (2012) Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 23:287–294CrossRefGoogle Scholar
  19. 19.
    Kim KM, Park JW, Lee JK, Lee KH, Lee KT, Shim SG (2015) A comparison of preoperative biliary drainage methods for perihilar cholangiocarcinoma: endoscopic versus percutaneous transhepatic biliary drainage. Gut Liver 9:791–799CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Al Mahjoub A, Menahem B, Fohlen A et al (2017) Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma: is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage? A meta-analysis. J Vasc Interv Radiol 28:576–582CrossRefPubMedGoogle Scholar
  21. 21.
    Miller DL, Vañó E, Bartal G et al (2010) Occupational radiation protection in interventional radiology: a joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. J Vasc Interv Radiol 21:607–615CrossRefPubMedGoogle Scholar
  22. 22.
    Karavasilis E, Dimitriadis A, Gonis H, Pappas P, Georgiou E, Yakoumakis E (2014) Effective dose in percutaneous transhepatic biliary drainage examination using PCXMC2.0 and MCNP5 Monte Carlo codes. Phys Med 30:432–436CrossRefPubMedGoogle Scholar
  23. 23.
    Etard C, Bigand E, Salvat C et al (2017) Patient dose in interventional radiology: a multicentre study of the most frequent procedures in France. Eur Radiol 27:4281–4290CrossRefPubMedGoogle Scholar
  24. 24.
    Degiorgio S, Gerasia R, Liotta F et al (2018) Radiation doses to operators in hepatobiliary interventional procedures. Cardiovasc Intervent Radiol 41:772–780PubMedGoogle Scholar
  25. 25.
    Yoshinaga S, Suzuki H, Oda I, Saito Y (2011) Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of solid pancreatic masses. Dig Endosc 23(Suppl 1):29–33CrossRefPubMedGoogle Scholar
  26. 26.
    Vander Noot MR 3rd, Eloubeidi M, Chen VK et al (2004) Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer 102:157–163CrossRefPubMedGoogle Scholar
  27. 27.
    Chen VK, Eloubeidi MA (2005) Endoscopic ultrasound-guided fine-needle aspiration of intramural and extraintestinal mass lesions: diagnostic accuracy, complication assessment, and impact on management. Endoscopy 37:984–989CrossRefPubMedGoogle Scholar
  28. 28.
    Mohkam K, Malik Y, Derosas C et al (2017) Percutaneous transhepatic cholangiographic endobiliary forceps biopsy versus endoscopic ultrasound fine needle aspiration for proximal biliary strictures: a single-centre experience. HPB (Oxford) 19:530–537CrossRefGoogle Scholar
  29. 29.
    Savader SJ, Prescott CA, Lund GB, Osterman FA (1996) Intraductal biliary biopsy: comparison of three techniques. J Vasc Interv Radiol 7:743–750CrossRefPubMedGoogle Scholar
  30. 30.
    Navaneethan U, Njei B, Lourdusamy V, Konjeti R, Vargo JJ, Parsi MA (2015) Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 81:168–176CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Tapping CR, Byass OR, Cast JE (2012) Cytological sampling versus forceps biopsy during percutaneous transhepatic biliary drainage and analysis of factors predicting success. Cardiovasc Intervent Radiol 35:883–889CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Audrey Fohlen
    • 1
    • 2
  • Celine Bazille
    • 2
    • 3
  • Benjamin Menahem
    • 4
    • 5
  • Marc Antoine Jegonday
    • 1
  • Benoit Dupont
    • 6
  • Vincent Le Pennec
    • 1
  • Jean Lubrano
    • 4
    • 5
  • Boris Guiu
    • 7
  • Jean Pierre Pelage
    • 1
    • 2
  1. 1.Department of Interventional and Diagnostic ImagingUniversity Hospital of CaenCaen CedexFrance
  2. 2.UNICAEN, CEA, CNRS, ISTCT/CERVOxy GroupNormandie UniversityCaenFrance
  3. 3.Department of AnatomopathologyUniversity Hospital of CaenCaen CedexFrance
  4. 4.Department of Digestive SurgeryUniversity Hospital of CaenCaen CedexFrance
  5. 5.UNICAEN, CEA, INSERM U1086Normandie UniversityCaen CedexFrance
  6. 6.Department of Hepato-Gastro-EnterologyUniversity Hospital of CaenCaen CedexFrance
  7. 7.Department of RadiologySt-Eloi University Hospital-MontpellierMontpellierFrance

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