Multiple bile duct biopsies using a sheath with a side port: usefulness of intraductal sonography.
OBJECTIVE
We clarified the number of biopsies required to determine malignancy of the biliary tract on the basis of the type of bile duct tumor.


METHODS
Patients with a biliary tract malignancy (n = 33) and a benign biliary stenosis (n = 3) underwent biopsy via the percutaneous transhepatic route. We performed intraductal sonography using a 20-MHz probe with a 2.0-mm diameter. The sonographic findings were prospectively classified as polypoid, circular, or semicircular. The tip of a long 9-French sheath with a side port was wedged into the stenosis, and six specimens were obtained with a 1.8-mm-diameter forceps with serrated cups.


RESULTS
When cholangiography or intraductal sonography showed a polypoid lesion, the sensitivity of two biopsies was 100% (6/6). When cholangiography showed a stenotic lesion, the sensitivity of nine biopsies (96%, 26/27) was superior to that of two biopsies (74%, 20/27; p < 0.05). When intraductal sonography showed a circular lesion, the sensitivity of three biopsies (100%, 14/14) was superior to that of a single biopsy (64%, 9/14; p < 0.05). When it showed a semicircular lesion, the sensitivity of nine biopsies (92%, 12/13) was superior to that of two biopsies (54%, 7/13; p < 0.05).


CONCLUSIONS
Bile duct biopsy using a sheath with a side port has a high sensitivity. However, the number of biopsies required depends on the cholangioscopic and intraductal sonographic appearance of the tumor.
Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi 329-0498, Japan.
K
K
Tamada
Y
Y
Satoh
T
T
Tomiyama
A
A
Ohashi
S
S
Wada
K
K
Ido
K
K
Sugano
D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology*; D001652:Bile Ducts / Q000473:pathology*; D001706:Biopsy / Q000295:instrumentation / Q000379:methods*; D018281:Cholangiocarcinoma / Q000473:pathology*; D002758:Cholangiography; D005260:Female; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D013048:Specimen Handling; D018084:Ultrasonography, Interventional / Q000295:instrumentation