title: Improved Accuracy of Percutaneous Biopsy Using "Cross and Push" Technique for Patients Suspected with Malignant Biliary Strictures.
abstract: OBJECTIVE
  Various methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.
  
  
  METHODS
  Fifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified "cross and push" technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing the stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.
  
  
  RESULTS
  We report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2%, respectively. There was one procedure-related late complication.
  
  
  CONCLUSIONS
  We propose that the modified "cross and push" technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree.
authors.affiliation: School of Cancer Sciences, Vincent Drive, University of Birmingham, Birmingham, B15 2TT, UK, p.patel@bham.ac.uk.
authors.forename: Prashant
authors.initials: P
authors.lastname: Patel
authors.forename: Balaji
authors.initials: B
authors.lastname: Rangarajan
authors.forename: Kamarjit
authors.initials: K
authors.lastname: Mangat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000473:pathology*; D001661:Biliary Tract Neoplasms / Q000175:diagnosis* / Q000473:pathology; D001706:Biopsy; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity