title: How many biopsies should be performed during percutaneous transhepatic cholangioscopy to diagnose biliary tract cancer?
abstract: BACKGROUND
  The sensitivity of biopsy in the diagnosis of cholangiocarcinoma using percutaneous transhepatic cholangioscopy is not well defined.
  
  
  METHODS
  Patients with a biliary tract malignancy (n = 52) underwent directed biopsy during percutaneous transhepatic cholangioscopy using a 1.8 mm diameter forceps. Histologic findings were correlated with endoscopic appearance.
  
  
  RESULTS
  A diagnosis of carcinoma was made in all four patients with a tumor of the major duodenal papilla and in all 15 patients with a polypoid bile duct tumor with two biopsies from the mass. In 19 patients with stenotic bile duct cancer, a positive diagnosis was made in 95% of cases when three biopsies were taken from the margin of the stenotic area. When cholangioscopy showed a tortuous, dilated vessel (n = 10), the diagnosis of cancer was made with two biopsies taken from the margin of the stenosis. In 14 patients with metastatic bile duct cancer, the diagnosis was made in only 43% of cases when three biopsies were taken from the margin of the stenosis. When combined with results from the three biopsies taken from within the area of stenosis, the sensitivity for diagnosing pancreatic cancer improved from 20% to 60%.
  
  
  CONCLUSIONS
  Directed cholangioscopic biopsies are highly sensitive for the diagnosis of cholangiocarcinoma but less sensitive for cancer metastatic to the bile duct. The numbers and locations of the biopsies required to make a diagnosis of carcinoma depend on the origin and cholangioscopic appearance of the tumor.
authors.affiliation: Department of Gastroenterology and Pathology, Jichi Medical School, Yakushiji, Tochigi, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tamada
authors.forename: K
authors.initials: K
authors.lastname: Kurihara
authors.forename: T
authors.initials: T
authors.lastname: Tomiyama
authors.forename: A
authors.initials: A
authors.lastname: Ohashi
authors.forename: S
authors.initials: S
authors.lastname: Wada
authors.forename: Y
authors.initials: Y
authors.lastname: Satoh
authors.forename: T
authors.initials: T
authors.lastname: Miyata
authors.forename: K
authors.initials: K
authors.lastname: Ido
authors.forename: K
authors.initials: K
authors.lastname: Sugano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000473:pathology*; D001661:Biliary Tract Neoplasms / Q000473:pathology*; D001706:Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D002277:Carcinoma / Q000473:pathology*; D016292:Procedural Sedation; D004106:Dilatation; D004322:Drainage; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity