Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 5/2019

01-05-2019 | Hepatobiliary-Pancreas

Transhepatic forceps biopsy combined with biliary drainage in obstructive jaundice: safety and accuracy

Authors: Audrey Fohlen, Celine Bazille, Benjamin Menahem, Marc Antoine Jegonday, Benoit Dupont, Vincent Le Pennec, Jean Lubrano, Boris Guiu, Jean Pierre Pelage

Published in: European Radiology | Issue 5/2019

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Katabathina VS, Dasyam AK, Dasyam N, Hosseinzadeh K (2014) Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics 34:565–586CrossRef
2.
Arrivé L, Hodoul M, Arbache A, Slavikova-Boucher L, Menu Y, El Mouhadi S (2015) Magnetic resonance cholangiography: current and future perspectives. Clin Res Hepatol Gastroenterol 39:659–664
3.
Singh A, Gelrud A, Agarwal B (2014) Biliary strictures: diagnostic considerations and approach. Gastroenterol Rep (Oxf) 3:22–31
4.
Tabibian JH, Visrodia KH, Levy MJ, Gostout CJ (2015) Advanced endoscopic imaging of indeterminate biliary strictures. World J Gastrointest Endosc 7:1268–1278CrossRefPubMedPubMedCentral
5.
Tringali A, Lemmers A, Meves V et al (2015) Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review. Endoscopy 47:739–753CrossRefPubMed
6.
de Bellis M, Sherman S, Fogel EL et al (2002) Tissue sampling at ERCP in suspected malignant biliary strictures (part 2). Gastrointest Endosc 56:720–730CrossRefPubMed
7.
Rösch T, Hofrichter K, Frimberger E et al (2004) ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc 60:390–396CrossRefPubMed
8.
Weilert F, Bhat YM, Binmoeller KF et al (2014) EUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction: results of a prospective, single-blind, comparative study. Gastrointest Endosc 80:97–104CrossRefPubMed
9.
De Moura DTH, Moura EGH, Bernardo WM et al (2016) Endoscopic retrograde cholangiopancreatography versus endoscopic ultrasound for tissue diagnosis of malignant biliary stricture: systematic review and meta-analysis. Endosc Ultrasound 7:10–19CrossRefPubMedCentral
10.
Lin M, Hair CD, Green LK et al (2014) Endoscopic ultrasound-guided fine-needle aspiration with on-site cytopathology versus core biopsy: a comparison of both techniques performed at the same endoscopic session. Endosc Int Open 2:220–223CrossRef
11.
Elyaderani MK, Gabriele OF (1980) Brush and forceps biopsy of biliary ducts via percutaneous transhepatic catheterization. Radiology 135:777–778
12.
Jung GS, Huh JD, Lee SU, Han BH, Chang HK, Cho YD (2002) Bile duct: analysis of percutaneous transluminal forceps biopsy in 130 patients. Radiology 7:725–730
13.
Omary RA, Bettmann MA, Cardella JF et al (2003) Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol 14:S293–S295
14.
Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF (2010) Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 21:789–795
15.
Ierardi AM, Mangini M, Fontana F et al (2013) Usefulness and safety of biliary percutaneous transluminal forceps biopsy (PTFB): our experience. Minim Invasive Ther Allied Technol 3:1–6
16.
Li TF, Ren KW, Han XW (2014) Percutaneous transhepatic cholangiobiopsy to determine the pathological cause of anastomotic stenosis after cholangiojejunostomy for malignant obstructive jaundice. Clin Radiol 69:13–17
17.
Patel P, Rangarajan B, Mangat K (2015) Improved accuracy of percutaneous biopsy using “cross and push” technique for patients suspected with malignant biliary strictures. Cardiovasc Intervent Radiol 38:1005–1010CrossRefPubMed
18.
Brown DB, Nikolic B, Covey AM et al (2012) Quality improvement guidelines for transhepatic arterial chemoembolization, embolization, and chemotherapeutic infusion for hepatic malignancy. J Vasc Interv Radiol 23:287–294CrossRefPubMed
19.
Kim KM, Park JW, Lee JK, Lee KH, Lee KT, Shim SG (2015) A comparison of preoperative biliary drainage methods for perihilar cholangiocarcinoma: endoscopic versus percutaneous transhepatic biliary drainage. Gut Liver 9:791–799
20.
Al Mahjoub A, Menahem B, Fohlen A et al (2017) Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma: is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage? A meta-analysis. J Vasc Interv Radiol 28:576–582CrossRefPubMed
21.
Miller DL, Vañó E, Bartal G et al (2010) Occupational radiation protection in interventional radiology: a joint guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology. J Vasc Interv Radiol 21:607–615CrossRefPubMed
22.
Karavasilis E, Dimitriadis A, Gonis H, Pappas P, Georgiou E, Yakoumakis E (2014) Effective dose in percutaneous transhepatic biliary drainage examination using PCXMC2.0 and MCNP5 Monte Carlo codes. Phys Med 30:432–436
23.
Etard C, Bigand E, Salvat C et al (2017) Patient dose in interventional radiology: a multicentre study of the most frequent procedures in France. Eur Radiol 27:4281–4290CrossRefPubMed
24.
Degiorgio S, Gerasia R, Liotta F et al (2018) Radiation doses to operators in hepatobiliary interventional procedures. Cardiovasc Intervent Radiol 41:772–780CrossRefPubMed
25.
Yoshinaga S, Suzuki H, Oda I, Saito Y (2011) Role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of solid pancreatic masses. Dig Endosc 23(Suppl 1):29–33CrossRefPubMed
26.
Vander Noot MR 3rd, Eloubeidi M, Chen VK et al (2004) Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer 102:157–163
27.
Chen VK, Eloubeidi MA (2005) Endoscopic ultrasound-guided fine-needle aspiration of intramural and extraintestinal mass lesions: diagnostic accuracy, complication assessment, and impact on management. Endoscopy 37:984–989CrossRefPubMed
28.
Mohkam K, Malik Y, Derosas C et al (2017) Percutaneous transhepatic cholangiographic endobiliary forceps biopsy versus endoscopic ultrasound fine needle aspiration for proximal biliary strictures: a single-centre experience. HPB (Oxford) 19:530–537CrossRef
29.
Savader SJ, Prescott CA, Lund GB, Osterman FA (1996) Intraductal biliary biopsy: comparison of three techniques. J Vasc Interv Radiol 7:743–750CrossRefPubMed
30.
Navaneethan U, Njei B, Lourdusamy V, Konjeti R, Vargo JJ, Parsi MA (2015) Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 81:168–176
31.
Tapping CR, Byass OR, Cast JE (2012) Cytological sampling versus forceps biopsy during percutaneous transhepatic biliary drainage and analysis of factors predicting success. Cardiovasc Intervent Radiol 35:883–889
Metadata
Title
Transhepatic forceps biopsy combined with biliary drainage in obstructive jaundice: safety and accuracy
Authors
Audrey Fohlen
Celine Bazille
Benjamin Menahem
Marc Antoine Jegonday
Benoit Dupont
Vincent Le Pennec
Jean Lubrano
Boris Guiu
Jean Pierre Pelage
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 5/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-018-5852-x

Other articles of this Issue 5/2019

European Radiology 5/2019 Go to the issue

Musculoskeletal

Soft tissue sarcoma: adding diffusion-weighted imaging improves MR imaging evaluation of tumor margin infiltration

Breast

Differentiation of triple-negative breast cancer from other subtypes through whole-tumor histogram analysis on multiparametric MR imaging

Computed Tomography

Diabetes risk assessment with imaging: a radiomics study of abdominal CT

Gastrointestinal

Ability of DWI to characterize bowel fibrosis depends on the degree of bowel inflammation

Hepatobiliary-Pancreas

New MRI features improve subtype classification of hepatocellular adenoma

Neuro

Validation of overestimation ratio and TL-SVS as imaging biomarker of cardioembolic stroke and time from onset to MRI