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Hong, Ryeom, Jang, Kim, Cho, and Song: Balloon Dilatation Biopsy of the Biliary Stricture through the Percutaneous Transhepatic Biliary Drainage Tract: Feasibility and Diagnostic Accuracy
Abdominal Radiology

Journal of the Korean Society of Radiology 2016; 74(1): 1-7.

Published online: 6 January 2016

DOI: https://doi.org/10.3348/jksr.2016.74.1.1

Balloon Dilatation Biopsy of the Biliary Stricture through the Percutaneous Transhepatic Biliary Drainage Tract: Feasibility and Diagnostic Accuracy

Ji-Hoon Hong, MD1, Hunkyu Ryeom, MD1, Yun-Jin Jang, MD1, Gab Chul Kim, MD1, Seung Hyun Cho, MD1, Jung Hup Song, MD2

1Department of Radiology, Kyungpook National University Hospital, Daegu, Korea.

2Public Health Medical Service, Kyungpook National University Hospital, Daegu, Korea.

Corresponding author: Hunkyu Ryeom, MD. Department of Radiology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea. Tel. 82-53-200-5390, Fax. 82-53-422-2677, hkryeom@knu.ac.kr

Received 11 August 2015       Revised 8 October 2015       Accepted 8 November 2015

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the feasibility and diagnostic accuracy of the balloon dilatation biopsy for the biliary stricture through the percutaneous transhepatic biliary drainage (PTBD) tract.

Materials and Methods

The study included 35 patients who underwent balloon dilatation biopsy for the biliary stricture through the PTBD tract. Balloon dilatation was done with a balloon catheter of 10-mm or 12-mm diameter. Soft tissue adherent to the retrieved balloon catheter and soft tissue components separated by gauze filtration of evacuated bile were sampled for histopathologic examination. The results were compared with the final diagnosis which was made by clinical and imaging follow-up for mean 989 days (n = 34) and surgery with histopathologic examination (n = 1). Procedure-related complications and diagnostic accuracy were assessed.

Results

Tissues suitable for histopathologic examination were obtained in 31 out of 35 patients (88.6%). In 3 patients, self-limiting hemobilia was noted. No major complication was noted. The sensitivity, specificity, diagnostic accuracy, positive and negative predictive values for diagnosis of malignant stricture were 70.0%, 100%, 90.3%, 100%, and 87.5%, respectively.

Conclusion

Balloon dilatation biopsy of the biliary stricture through the PTBD tract is a feasible and accurate diagnostic method. It can be a safe alternative to the endoscopic retrograde cholangiography biopsy or forceps biopsy through the PTBD tract.

Keywords: Radiology, Interventional, Biopsy, Bile Ducts, Cholangiocarcinoma

Figures and Tables

Fig. 1

Photograph of soft tissue fragments adherent to the retrieved balloon catheter and soft tissue components separated by gauze filtration of evacuated bile.

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Fig. 2

An 87-year-old female with benign stricture due to chronic pancreatitis.

A. Preprocedure cholangiogram shows abrupt narrowing (arrow) of the distal common bile duct.
B. Radiograph obtained during balloon dilatation biopsy shows an irregular waist (arrows) over the partially inflated balloon. A specimen satisfactory for histopathologic examination was obtained by balloon dilatation biopsy, and the lesion correctly diagnosed as a benign stricture.
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Fig. 3

A 63-year-old female who is presented with fever.

A. Cholangiogram obtained during the PTBD shows abrupt narrowing (arrow) of CBD and diffusely dilated biliary trees.
B. Radiograph obtained during balloon dilatation biopsy shows an asymmetric waist over the partially inflated balloon (arrow). A specimen suitable for histopathologic examination was obtained by balloon dilatation biopsy, and correctly diagnosed as a malignant stricture (cholangiocarcinoma).
C. Follow-up cholangiogram obtained 5 months after placement of the metallic stent shows occlusion of the stent due to tumor ingrowth (arrow).
CBD = common bile duct, PTBD = percutaneous transhepatic biliary drainage
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Table 1

Final Diagnosis and Causes of 35 Patients with Biliary Stricture

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Final Diagnosis Cause of Stricture No. of Patients
Benign stricture (n = 24) Chronic pancreatitis 13
Postsurgical 2
Cholangitis 1
Unknown 8
Malignant stricture (n = 11) CBD cholangiocarcinoma 7
Hilar cholangiocarcinoma 4

CBD = common bile duct

Table 2

Sampling Adequacy of Balloon Dilatation Biopsy and Histopathologic Results in 35 Patients with Biliary Stricture

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Final Diagnosis No. of Adequate Sampling Histopathologic Diagnosis No. of Patients
Benign stricture (n = 24) 21 (87.5%) No sign of malignancy 19
Presence of atypical cells 2
Malignant stricture (n = 11) 10 (90.9%) Cholangiocarcinoma 7
Chronic inflammation 2
Presence of atypical cells 1
Table 3

Final Diagnosis and Histopathologic Results of Balloon Dilatation Biopsy in 31 Patients with Adequate Sampling

jksr-74-1-i003
Final Diagnosis Result of Balloon Dilatation Biopsy
Benign Stricture Malignant Stricture
Benign stricture (n = 21) 21 (19) 0 (2)
Malignant stricture (n = 10) 3 (2) 7 (8)

Numbers in parentheses are numbers of patients when 'presence of atypical cells' consider as malignant stricture.

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