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Cytological Sampling Versus Forceps Biopsy During Percutaneous Transhepatic Biliary Drainage and Analysis of Factors Predicting Success

CardioVascular and Interventional Radiology volume 35, pages 883–889 (2012)Cite this article

Abstract

Purpose

To assess the accuracy of cytological sampling and forceps biopsy in obstructing biliary lesions and to identify factors predictive of success.

Methods

Consecutive patients (n = 119) with suspected malignant inoperable obstructive jaundice treated with percutaneous transhepatic biliary drainage during 7 years were included (60 male; mean age 72.5 years). All patients underwent forceps biopsy plus cytological sampling by washing the forceps device in cytological solution. Patient history, procedural and pathological records, and clinical follow-up were reviewed. Statistical analysis included chi-square test and multivariate regression analysis.

Results

Histological diagnosis after forceps biopsy was more successful than cytology: Sensitivity was 78 versus 61%, and negative predictive value was 30 versus 19%. Cytology results were never positive when the forceps biopsy was negative. The cytological sample was negative and forceps sample positive in 2 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 1 case of benign disease. Diagnostic accuracy was predicted by low bilirubin (p < 0.001), aspartate transaminase (p < 0.05), and white cell count (p ≤ 0.05).

Conclusions

This technique is safe and effective and is recommended for histological diagnosis during PTBD in patients with inoperable malignant biliary strictures. Diagnostic yield is greater when bilirubin levels are low and there is no sepsis; histological diagnosis by way of forceps biopsy renders cytological sampling unnecessary.

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Acknowledgments

We thank Victoria Allgar (Hull and York Medical School) for assistance in statistical analysis of the data. This study was presented orally at the British Society of Interventional Radiology Meeting Nov 2010 (Liverpool, UK).

Conflict of interest

The authors declare no conflicts of interest.

Author information

Affiliations

  1. Department of Radiology, Hull Royal Infirmary, Hull, HU3 2JZ, UK

    C. R. Tapping, O. R. Byass & J. E. I. Cast

  2. Department of Radiology, Hull and East Yorkshire NHS Trust, Castle Hill Hospital, Castle Road, Kingston-Upon-Hull, Cottingham, Hull, HU16 5JQ, UK

    J. E. I. Cast

Authors
  1. C. R. Tapping
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  2. O. R. Byass
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  3. J. E. I. Cast
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Corresponding author

Correspondence to J. E. I. Cast.

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Tapping, C.R., Byass, O.R. & Cast, J.E.I. Cytological Sampling Versus Forceps Biopsy During Percutaneous Transhepatic Biliary Drainage and Analysis of Factors Predicting Success. Cardiovasc Intervent Radiol 35, 883–889 (2012). https://doi.org/10.1007/s00270-011-0193-z

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  • DOI: https://doi.org/10.1007/s00270-011-0193-z

Keywords

  • Forceps biopsy
  • Cytological sampling
  • Biliary system
  • Percutaneous transhepatic biliary drainage