Factors affecting the yield of endoscopic transpapillary bile duct biopsy for the diagnosis of pancreatic head cancer.
BACKGROUND
Transpapillary biliary biopsy (TBB) is a simple endoscopic technique that can be performed during an initial biliary drainage session. This procedure has the potential to reduce the load of another tissue sampling in cases of pancreatic head cancer (PHC) with biliary stricture. The aim of this study is to identify factors associated with a positive outcome using TBB for PHC.


METHODS
In total, 130 cases that underwent TBB for investigation of distal biliary stricture were included [62 cases of PHC, 36 cases of distal biliary cancer (DBC), and 32 cases of benign biliary stricture (BBS)]. Factors affecting the diagnostic efficiency of TBB were determined using univariate and multivariate logistic analyses.


RESULTS
Cancer tissue was obtained in 31 cases (50%) of PHC and 33 cases (91.7%) of DBC. Multivariable analysis showed that ≧10 mg/dl of serum bilirubin level (odds ratio [OR]: 5.58; 95% confidence interval [CI]: 1.29-28.20; P = 0.021) and ≧3 tissue samplings (OR: 3.59; 95% CI: 1.02-14.27, P = 0.046) were independent factors affecting cancer-positive rate in cases of PHC. In >90% of resected cases of PHC, cancer involved the left side of the biliary mucosa and the range of cancer invasion (≧2/3 of circumference of biliary mucosa) was also a significant factor (P = 0.001).


CONCLUSIONS
PHC showing high level of serum bilirubin (>10 mg/dl) and high circumferential proportion of bile duct invasion (>2/3 judging from MDCT) is a good indication for biliary biopsy. Targeting the left-side wall and ≧3 tissue samplings will lead to the higher sensitivity.
Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka 411-8777, Japan; Division of Pathology, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka 411-8777, Japan.
Hirokazu
H
Kimura
Hiroyuki
H
Matsubayashi
Keiko
K
Sasaki
Hiroaki
H
Ito
Kenichi
K
Hirosawa
Katsuhiko
K
Uesaka
Hideyuki
H
Kanemoto
Hiroyuki
H
Ono
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology; D001652:Bile Ducts / Q000473:pathology*; D001663:Bilirubin / Q000097:blood; D001706:Biopsy / Q000379:methods; D003251:Constriction, Pathologic / Q000175:diagnosis; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography
D001663:Bilirubin
Biliary biopsy; Biliary stricture; Diagnosis; Endoscopic retrograde cholangiopancreatography; Pancreatic cancer