Intraductal biliary biopsy: comparison of three techniques.
OBJECTIVE
To compare the results obtained with three different techniques for percutaneous transhepatic intraductal biopsy.


METHODS
Eighty-eight patients with obstructive jaundice underwent placement of percutaneous biliary drainage catheters for biliary decompression. As part of the initial procedure or at a subsequent date, intraductal biliary biopsy (n = 109) was performed with use of one or more of three techniques including cytologic brush (n = 53), clamshell forceps under choledochoscopic guidance (n = 31), and clamshell forceps under fluoroscopic guidance (n = 25).


RESULTS
Forty-eight patients (55%) had a final diagnosis of malignant disease, and 40 (45%) had a diagnosis of benign disease. One hundred six (97%) biopsy procedures yielded technically adequate specimens. No complications directly related to the biopsy procedures occurred. Overall sensitivity and specificity for each biopsy technique were 26% and 96% for the cytologic brush technique, 30% and 88% for the clamshell forceps under fluoroscopic guidance technique, and 44% and 100% for the clamshell forceps under choledochoscopic guidance technique, respectively. The sensitivities of the biopsy techniques for pancreatic carcinoma and cholangiocarcinoma, respectively, were 47% and 0% for brush; 75% and 0% for fluoroscopic clamshell; and 100% and 27% for choledochoscopic clamshell.


CONCLUSIONS
The choledochoscope-directed biopsy technique had the greatest sensitivity and specificity of the three techniques evaluated, but this difference was not statistically significant versus the brush or fluoroscopic clamshell technique (P > .10). The sensitivity of all three techniques for pancreatic carcinoma was significantly greater than that for cholangiocarcinoma. Multiple biopsies did not increase the overall sensitivity of intraductal biliary biopsy as a diagnostic technique. All three techniques proved to be safe and easy to perform.
Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
S J
SJ
Savader
C A
CA
Prescott
G B
GB
Lund
F A
FA
Osterman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D001706:Biopsy / Q000295:instrumentation / Q000379:methods*; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology; D002404:Catheterization / Q000295:instrumentation; D002648:Child; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods; D002779:Cholestasis / Q000628:therapy; D003581:Cytodiagnosis / Q000295:instrumentation; D004322:Drainage / Q000295:instrumentation; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology; D011237:Predictive Value of Tests; D015641:Radiography, Interventional; D012680:Sensitivity and Specificity