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

Authors:
Audrey Fohlen
Audrey Fohlen
University Hospital
France
Celine Bazille
Celine Bazille
Normandie Univ
Benjamin Menahem
Benjamin Menahem
University Hospital of Caen
Marc Antoine Jegonday
Marc Antoine Jegonday
University Hospital of Caen
Jean Lubrano
Jean Lubrano
Rouen University Hospital
France
Boris Guiu
Boris Guiu
University of Dijon School of Medicine
France

Eur Radiol 2019 May 3;29(5):2426-2435. Epub 2018 Dec 3.

Department of Interventional and Diagnostic Imaging, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France.

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.

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-018-5852-xDOI Listing

Still can't find the full text of the article?

We can help you send a request to the authors directly.
May 2019
8 Reads

Publication Analysis

Top Keywords

tissue sampling
12
biliary drainage
12
forceps biopsy
12
obstructive jaundice
8
tumour cells
8
biliary
8
safety accuracy
8
ptfb ptbd
8
biopsy
8
accuracy
6
sensitivity
5
patients
5
ptfb
5
• percutaneous
4
location pre-operative
4
pre-operative imaging
4
accuracy calculated
4
percutaneous transbiliary
4
calculated influence
4
imaging findings
4

References

(Supplied by CrossRef)
Article in Radiographics
VS Katabathina et al.
Radiographics 2014
Article in World J Gastrointest Endosc
JH Tabibian et al.
World J Gastrointest Endosc 2015
Article in Endoscopy
A Tringali et al.
Endoscopy 2015
Article in Gastrointest Endosc
M Bellis de et al.
Gastrointest Endosc 2002
Article in Gastrointest Endosc
T Rösch et al.
Gastrointest Endosc 2004
Article in Gastrointest Endosc
F Weilert et al.
Gastrointest Endosc 2014
Article in Endosc Ultrasound
DTH Moura De et al.
Endosc Ultrasound 2016
Article in Endosc Int Open
M Lin et al.
Endosc Int Open 2014

Similar Publications