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Bile Duct: Analysis of Percutaneous Transluminal Forceps Biopsy in 130 Patients Suspected of Having Malignant Biliary Obstruction¹

¹ From the Departments of Diagnostic Radiology (G.S.J., J.D.H., Y.D.C.), Internal Medicine (S.U.L., B.H.H.), and Pathology (H.K.C.), College of Medicine, Kosin University, 34 Amnam-Dong, Seo-Gu, Pusan 602-702, South Korea. From the 2001 RSNA scientific assembly. Received September 10, 2001; revision requested November 9; revision received January 8, 2002; accepted January 29. Address correspondence to G.S.J. (e-mail: gsjung@ns.kosinmed.or.kr).

PURPOSE: To evaluate percutaneous transluminal forceps biopsy in patients suspected of having a malignant biliary obstruction.

MATERIALS AND 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 ² test; a P value .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.

CONCLUSION: 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.

© RSNA, 2002

Index terms: Bile ducts, biopsy, 76.1261 • Bile ducts, neoplasms, 76.321 • Biopsies, technology, 76.1261