Bile duct: analysis of percutaneous transluminal forceps biopsy in 130 patients suspected of having malignant biliary obstruction.
OBJECTIVE
To evaluate percutaneous transluminal forceps biopsy in patients suspected of having a malignant biliary obstruction.


METHODS
One hundred thirty consecutive patients (82 men and 48 women; mean age, 59 years) with obstructive jaundice underwent transluminal forceps biopsy during or after percutaneous transhepatic biliary drainage. The lesions involved the common bile duct (n = 58), common hepatic duct (n = 39), hilum (n = 14), ampullary segment of the common bile duct (n = 11), right or left intrahepatic bile duct (n = 5), or the entire extrahepatic bile duct (n = 3). In each patient, three to five specimens (mean, 4.1 specimens) were taken from the lesion with 5.4-F biopsy forceps. The final diagnosis for each patient was confirmed with pathologic findings at surgery, additional histocytologic data, or clinical and radiologic follow-up. Statistical analysis was performed with the chi(2) test; a P value < or =.05 was considered to indicate a significant difference.


RESULTS
Ninety-eight of 130 biopsies resulted in correct diagnoses of malignancy. Five biopsy diagnoses proved to be true-negative. There were 27 false-negative diagnoses and no false-positive diagnoses. The diagnostic performance of transluminal forceps biopsy in malignant biliary obstructions was as follows: sensitivity, 78.4%; specificity, 100%; and accuracy, 79.2%. Sensitivity of biopsy in the 82 patients with cholangiocarcinoma was higher than in the 43 patients with malignant tumors other than cholangiocarcinoma (86.6% vs 62.8%, P <.005). Sensitivity was significantly lower in the ampullary segment of the common bile duct than in other sites (P <.01). No major complications related to the biopsy procedures occurred.


CONCLUSIONS
Percutaneous transluminal forceps biopsy is a safe procedure that is easy to perform through a transhepatic biliary drainage tract. It provides relatively high accuracy in the diagnosis of malignant biliary obstructions.
Department of Diagnostic Radiology, College of Medicine, Kosin University, 34 Amnam-Dong, Seo-Gu, Pusan 602-702, South Korea. gsjung@ns.kosinmed.or.kr
Gyoo-Sik
GS
Jung
Jin-Do
JD
Huh
Sang Uk
SU
Lee
Byung Hoon
BH
Han
Hee-Kyung
HK
Chang
Young Duk
YD
Cho
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000473:pathology*; D017734:Bile Ducts, Extrahepatic / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D001661:Biliary Tract Neoplasms / Q000473:pathology*; D001706:Biopsy / Q000379:methods*; D002779:Cholestasis / Q000473:pathology*; D003135:Common Bile Duct / Q000473:pathology; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013525:Surgical Instruments