Audrey Fohlen1,2, Celine Bazille3,4, Benjamin Menahem5,6, Marc Antoine Jegonday7, Benoit Dupont8, Vincent Le Pennec7, Jean Lubrano5,6, Boris Guiu9, Jean Pierre Pelage7,3. 1. Department of Interventional and Diagnostic Imaging, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France. fohlen@cyceron.fr. 2. UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, Normandie University, 14000, Caen, France. fohlen@cyceron.fr. 3. UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, Normandie University, 14000, Caen, France. 4. Department of Anatomopathology, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France. 5. Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France. 6. UNICAEN, CEA, INSERM U1086, Normandie University, 14045, Caen Cedex, France. 7. Department of Interventional and Diagnostic Imaging, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France. 8. Department of Hepato-Gastro-Enterology, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France. 9. Department of Radiology, St-Eloi University Hospital-Montpellier, 80, Avenue Augustin Fliche, 34295, Montpellier, France.
Abstract
PURPOSE: This study was conducted in order to investigate the safety and accuracy of percutaneous transluminal forceps biopsy (PTFB) during percutaneous biliary drainage (PTBD) in patients with a suspicion of malignant biliary stricture. MATERIAL AND METHODS: Fifty consecutive patients with obstructive jaundice underwent PTFB during PTBD. Biopsy specimens were obtained using 5.2-F flexible biopsy forceps and these specimens were independently analysed by two pathologists. Consensus was obtained in case of discrepancy. Biopsy was considered as a true positive when tumour cells were retrieved. In the absence of tumour cells, comparison with available surgical findings and/or endoscopic ultrasound fine-needle aspiration (EUS-FNA) and/or percutaneous liver biopsy and/or imaging or clinical follow-up was made to distinguish true and false negatives. Specificity, sensitivity, positive predictive value, negative predictive value and accuracy were calculated. Influence of tumour location and pre-operative imaging findings was evaluated. Adverse events were reported. RESULTS: Biliary drainage and tissue sampling were achieved in 100% of patients. Sensitivity and specificity were 70 and 100%, respectively, while overall accuracy was 72%. After excluding the first 25 patients, accuracy and sensitivity for tissue sampling reached 80 and 78%, respectively. Sensitivity was better (87%) if stenosis was located at the upper part of the biliary tree, compared to the lower part (55%). In case of cholangiocarcinoma or intraductal invasion suspected on imaging, biopsy was contributive in 84 and 81% of patients, respectively. Four complications occurred consisting of one bile leak, two haemobilia and one pneumoperitoneum. CONCLUSION: PTFB combined with PTBD is a safe and effective technique for both histopathological diagnosis and biliary decompression of biliary strictures. KEY POINTS: Implications for patient care: • Percutaneous transbiliary forceps biopsy is technically feasible (100% of tissue sampling in our study) and is a safe technique. • Radiological management combining PTFB plus PTBD may allow diagnosis and treatment of the biliary stricture at the same time. • Sensitivity and accuracy for PTFB reached 78 and 80%, respectively, with a 100% specificity.
PURPOSE: This study was conducted in order to investigate the safety and accuracy of percutaneous transluminal forceps biopsy (PTFB) during percutaneous biliary drainage (PTBD) in patients with a suspicion of malignant biliary stricture. MATERIAL AND METHODS: Fifty consecutive patients with obstructive jaundice underwent PTFB during PTBD. Biopsy specimens were obtained using 5.2-F flexible biopsy forceps and these specimens were independently analysed by two pathologists. Consensus was obtained in case of discrepancy. Biopsy was considered as a true positive when tumour cells were retrieved. In the absence of tumour cells, comparison with available surgical findings and/or endoscopic ultrasound fine-needle aspiration (EUS-FNA) and/or percutaneous liver biopsy and/or imaging or clinical follow-up was made to distinguish true and false negatives. Specificity, sensitivity, positive predictive value, negative predictive value and accuracy were calculated. Influence of tumour location and pre-operative imaging findings was evaluated. Adverse events were reported. RESULTS: Biliary drainage and tissue sampling were achieved in 100% of patients. Sensitivity and specificity were 70 and 100%, respectively, while overall accuracy was 72%. After excluding the first 25 patients, accuracy and sensitivity for tissue sampling reached 80 and 78%, respectively. Sensitivity was better (87%) if stenosis was located at the upper part of the biliary tree, compared to the lower part (55%). In case of cholangiocarcinoma or intraductal invasion suspected on imaging, biopsy was contributive in 84 and 81% of patients, respectively. Four complications occurred consisting of one bile leak, two haemobilia and one pneumoperitoneum. CONCLUSION:PTFB combined with PTBD is a safe and effective technique for both histopathological diagnosis and biliary decompression of biliary strictures. KEY POINTS: Implications for patient care: • Percutaneous transbiliary forceps biopsy is technically feasible (100% of tissue sampling in our study) and is a safe technique. • Radiological management combining PTFB plus PTBD may allow diagnosis and treatment of the biliary stricture at the same time. • Sensitivity and accuracy for PTFB reached 78 and 80%, respectively, with a 100% specificity.
Entities:
Keywords:
Bile; Bile duct neoplasms; Biopsy; Drainage; Obstructive jaundice
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