[Instrumental diagnosis of obstructive jaundice: brushing versus biopsy].
We report on a series of 60 patients (31 men and 29 women; mean age: 63 years, range: 37-87 years) submitted to brushing and/or biopsy of the biliary tree through a percutaneous biliary drainage. The tumor involved the biliary bifurcation in 13 cases (21.7%), the biliary duct in 32 cases (53.4%), the right hepatic duct in 1 case (1.6%) and the left hepatic duct in 1 case (1.6%). The metal endoprosthesis was obstructed in 6 cases (10%), while a stenosis of the biliodigestive anastomosis was shown in 7 cases. We used a particular bristle brush and a flexible forceps of the alligator type for cholangioscopic biopsy. Forty-three patients had a malignant stenosis; the diagnosis was confirmed histologically and with clinical follow-up. The comparative adequacy of brushing versus biopsy resulted as follows: 33.3% versus 89.6% sensitivity, 100% specificity for both methods and 59.3% versus 89.6% accuracy. We had 14 versus 3 false negatives and no false positives. Neither brushing nor biopsy brought about any complications. To conclude, biopsy is more accurate and sensitive than brush cytology (91.6% vs 59.3% and 89.6% vs 33.3%, respectively) and therefore it is a safer and faster method to diagnose obstructive jaundice.
Rossi
M
M
Istituto di Radiologia, III Cattedra, Roma.
Lemos
A
A
Bonaiuti
P
P
Amoruso
M
M
Petrone
A
A
Petrozza
V
V
Benvenuto
A
A
Rossi
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000209:etiology / Q000473:pathology; D001706:Biopsy; D002779:Cholestasis / Q000209:etiology / Q000473:pathology*; D016145:Endoscopy, Digestive System / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies