Transhepatic forceps biopsy after PTCD for histological assessment of bile duct stenoses or occlusions

Abstract

Purpose The goal of this study was to evaluate the experience of 11 years of wire-guided forceps biopsy via PTCD in patients with obstructive jaundice.

Materials and methods In a retrospective approach, 56 biopsies in 51 patients were analyzed (22 female, 29 male). Data was collected from 2006 to 2016. Mean age was 71 years (range: 34 – 86 years). Data was extracted from dig. Patients’ records (KIS, PACS, RIS) to be analyzed in Microsoft Excel.

Results All 56 procedures were technically successful. Stenosis in anastomoses were benign due to scarring in 7 patients and in 9 due to papillitis or others. In 4 patients, results in anastomosis were malignant. In 19 patients without anastomosis, CCC was the diagnosis, thereof 10 klatskin, 9 stenosis in other locations, followed by gastric, pancreatic, and colon carcinoma in 5, 3, and 2 patients. Three patients had a CUP (multimetering in case of more than 1 related category). Overall results were 35 mal. and 16 benign, 76.8 % of all proc. had a correct histopathologic result, and 23.2 % were false negative. Sensitivity was 65.8 %, which results in negative predictive value of 58.1 %. There was no false positive and so specificity was 100 %, as was the positive predictive value. False negative results (no malignancy but clinically and imaging suspect) were corrected by rerunning the procedure, by CT-guided biopsy or by 1 PET-CT. In 1 case the surg. sample brought the result. Minor complications occurred in 8 patients: shivering in 1 case, distinct but hemodynamically not relevant hemobilia in 5 cases, 2 portovenal bleedings. All bleedings were short-term and self-limiting.

Conclusion Despite good feasibility, low peri- and post-interv. risk and high validity the forceps biopsy via PTCD is not widely used. For experienced interventionalists, it is an effective method for obtaining histology.

Zusammenfassung

Ziel Auswertung der Ergebnisse aus 11 Jahren transhepatisch drahtgeführter Zangenbiopsie der Gallengänge bei Patienten mit Cholestase.

Material und Methode Retrospektive Aufarbeitung von 51 Patienten (22 weiblich, 29 männlich), mit – von 2006 bis 2016 – 56 Biopsien. Alters-Median: 71 Jahre (Range: 34 – 86). Die Daten wurden anhand des KIS und der Befunddok. (PACS, RIS) erhoben und in Microsoft Excel ^® ausgewertet.

Ergebnisse Alle 56 Biopsien waren technisch erfolgreich. 7 Patienten hatten narbige benigne Stenosen bei biliodig. Anastomosen, 9 durch Papillitis oder sonstige. 4 Patienten boten ein Rezidiv eines Primärtumors. Bei 19 Patienten ohne Anastomose war ein CCC die Ursache, davon 10 Klatskintumoren, 9 andere Gangabschnitte, gefolgt von Magen-, Pankreas- und Kolonkarzinom bei 5, 3 und 2 Patienten. 3 Patienten hatten ein CUP (Mehrfachnennung bei Diagnosematching). Es traten 35 maligne und 16 benigne Histologien auf.

76,8 % der Eingriffe brachten ein korrektes histologisches Ergebnis, 23,2 % fielen falsch negativ aus. Die Sensitivität betrug 65,8 %. Der negative prädiktive Wert 58,1 %. Spezifität und positiver Vorhersagewert betrugen 100 %. Falsch negative Ergebnisse (keine Malignität aber klinisch u. bildmorphologisch suspekt) wurden durch erneuten Eingriff, CT-gesteuerte Punktion oder ein PET-CT korrigiert. Einmal führte die OP zur Histologie.

Minorkomplik. traten bei 8 Patienten auf, darunter Kältezittern 1-mal, klinisch nicht relevante Hämobilie 5-mal. Diese Blutungen aus dem biopsierten Gewebe sistierten wie auch 2 portalven. Blutungen in die Gallenwege spontan.

Schlussfolgerung Bei guter Durchführbarkeit, geringem periinterv. Risiko und hoher Aussagekraft ist die Methode wenig verbreitet. Erfahrenen Interventionalisten bietet sich eine effektive Methode zur Histologiegewinnung.

Key words

bile ducts - tumor occlusion - PTCD - biopsy

Schlüsselwörter

Gallengänge - Tumorverschluss - PTCD - Biopsie

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