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

European Radiology volume 29, pages 2426–2435 (2019)Cite this article

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.

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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

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Funding

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

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Authors and Affiliations

  1. Department of Interventional and Diagnostic Imaging, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France

    Audrey Fohlen, Marc Antoine Jegonday, Vincent Le Pennec & Jean Pierre Pelage

  2. UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, Normandie University, 14000, Caen, France

    Audrey Fohlen, Celine Bazille & Jean Pierre Pelage

  3. Department of Anatomopathology, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France

    Celine Bazille

  4. Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France

    Benjamin Menahem & Jean Lubrano

  5. UNICAEN, CEA, INSERM U1086, Normandie University, 14045, Caen Cedex, France

    Benjamin Menahem & Jean Lubrano

  6. Department of Hepato-Gastro-Enterology, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France

    Benoit Dupont

  7. Department of Radiology, St-Eloi University Hospital-Montpellier, 80, Avenue Augustin Fliche, 34295, Montpellier, France

    Boris Guiu

Authors
  1. Audrey Fohlen
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  2. Celine Bazille
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  3. Benjamin Menahem
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  4. Marc Antoine Jegonday
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  5. Benoit Dupont
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  6. Vincent Le Pennec
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  7. Jean Lubrano
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  8. Boris Guiu
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  9. Jean Pierre Pelage
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Corresponding author

Correspondence to Audrey Fohlen.

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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

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Fohlen, A., Bazille, C., Menahem, B. et al. Transhepatic forceps biopsy combined with biliary drainage in obstructive jaundice: safety and accuracy. Eur Radiol 29, 2426–2435 (2019). https://doi.org/10.1007/s00330-018-5852-x

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  • DOI: https://doi.org/10.1007/s00330-018-5852-x

Keywords

  • Bile
  • Obstructive jaundice
  • Drainage
  • Biopsy
  • Bile duct neoplasms