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Efficacy of percutaneous image-guided biopsy for diagnosis of intrahepatic cholangiocarcinoma

  • Special Section: Cross sectional interventions
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the efficacy of percutaneous biopsy for diagnosing intrahepatic cholangiocarcinoma (IHCCA).

Methods

Retrospective review of biopsy and pathology databases from 2006 to 2019 yielded 112 patients (54F/58 M; mean age, 62.9 years; 27 cirrhotic) with IHCCA who underwent percutaneous biopsy. Data regarding the lesion, biopsy procedure technique, and diagnostic yield were collected. If biopsy was non-diagnostic or discordant with imaging, details of repeat biopsy or resection/explant were gathered. A control group of 100 consecutive patients (56F/44 M; mean age, 63 years, 5 cirrhotic) with focal liver lesions > 1 cm was similarly assessed.

Results

Mean IHCCA lesion size was 6.1 ± 3.6 cm, with dominant lesion sampled in 78% (vs. satellite in 22%). 95% (n = 106) were US guided and 96% were core biopsies (n = 108), typically 18G (n = 102, 91%), median 2 passes. 18 patients (16%) had discordant/ambiguous pathology results requiring repeat biopsy, with two patients requiring 3–4 total attempts. A 4.4% minor complication rate was seen. Mean time from initial biopsy to final diagnosis was 60 ± 120 days. Control group had mean lesion size of 2.9 ± 2.5 cm and showed a non-diagnostic rate of 3.3%, both significantly lower than that seen with CCA, with average time to diagnosis of 21 ± 28.8 days (p = 0.002, p = 0.001).

Conclusion

IHCCA is associated with lower diagnostic yield at initial percutaneous biopsy, despite larger target lesion size. If a suspicious lesion yields a biopsy result discordant with imaging, the radiologist should recommend prompt repeat biopsy to prevent delay in diagnosis.

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Authors and Affiliations

  1. Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA

    Meghan G. Lubner, Will G. Larison, Shane A. Wells, Timothy J. Ziemlewicz & Perry J. Pickhardt

  2. Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, USA

    Rao Watson

  3. Division of Medical Oncology, Department of Internal Medicine, School of Medicine and Public Health, Madison, USA

    Sam J. Lubner

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  1. Meghan G. Lubner
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  2. Will G. Larison
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  3. Rao Watson
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  4. Shane A. Wells
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  5. Timothy J. Ziemlewicz
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Correspondence to Meghan G. Lubner.

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Conflict of interest

Meghan G. Lubner received prior grant funding from Ethicon and Philips. Shane A. Wells declares that he is a consultant in Ethicon. Timothy J. Ziemlewicz declares that he is a consultant in Ethicon and Histosonics. Sam J. Lubner has a new disclosure, now serving as a consultant and shareholder for Elephas. Perry J. Pickhardt declares that he is an advisor to Bracco and is a shareholder in Elucent, SHINE, and Cellectar Biosciences.

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Lubner, M.G., Larison, W.G., Watson, R. et al. Efficacy of percutaneous image-guided biopsy for diagnosis of intrahepatic cholangiocarcinoma. Abdom Radiol 47, 2647–2657 (2022). https://doi.org/10.1007/s00261-021-03278-3

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  • DOI: https://doi.org/10.1007/s00261-021-03278-3

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