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Impact of Cholestasis on the Sensitivity of Percutaneous Transluminal Forceps Biopsy in 93 Patients with Suspected Malignant Biliary Stricture

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Abstract

Purpose

The aim of this study was to determine the effect of hyperbilirubinemia in the sensitivity of percutaneous transluminal forceps biopsy (PTFB) in patients with suspected malignant biliary stricture.

Materials and Methods

Ninety-three patients with suspicion of malignant biliary stricture underwent percutaneous transhepatic cholangiography followed by PTFB. Sensitivity, specificity and predictive values were analysed based on the presence or absence of hyperbilirubinemia, defined as total bilirubin equal to, or higher than 5 mg/dL. Variables included demographic and clinical features, laboratory, tumour type and localization, stricture length, therapeutic approach and histopathology. Additionally, major morbidity and mortality were assessed.

Results

The overall sensitivity, specificity, positive predictive value and accuracy of PTFB were 61.1%, 100%, 100%, and 62.4%, respectively. Hyperbilirubinemia affected 57% of patients at the time of PTFB. There were 35 (37%) false negative results, none of them related to tumour type or localization, stricture length, or previous biliary intervention (i.e. PBBD (percutaneous biliary balloon dilatation), ERCP (endoscopic retrograde cholangiopancreatography)) (p > 0.05). However, when bilirubin was < 5 mg/dL, false negative results decreased globally (p = 0.024) and sensitivity increased significantly for intrahepatic and hilar localization, as well as for colorectal metastasis, gallbladder carcinoma, and pancreatic carcinoma. No major morbidity occurred.

Conclusion

The sensitivity of percutaneous transluminal biopsy for diagnosis of malignant stricture may significantly increase if samples are obtained in the absence of hyperbilirubinemia, without adding morbidity to the procedure.

Level of Evidence

Level 3, Case- Control studies.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Division of Image Guided Minimally Invasive Surgery, Juan D. Perón 4190 (C1181ACH), Ciudad autónoma de Buenos Aires, Argentina

    Aldo Sebastián Oggero, Florencia Di Rocco, Pablo Ezequiel Huespe & Sung Ho Hyon

  2. Division of HPB Surgery and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Martín de Santibañes, Rodrigo Sanchez Claria, Oscar María Mazza, Juan Pekolk & Eduardo de Santibañes

  3. Department of Pathology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Eduardo Mullen

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  1. Aldo Sebastián Oggero
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  2. Florencia Di Rocco
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Correspondence to Aldo Sebastián Oggero.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. The study was accepted by a local institutional review board.

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Oggero, A.S., Di Rocco, F., Huespe, P.E. et al. Impact of Cholestasis on the Sensitivity of Percutaneous Transluminal Forceps Biopsy in 93 Patients with Suspected Malignant Biliary Stricture. Cardiovasc Intervent Radiol 44, 1618–1624 (2021). https://doi.org/10.1007/s00270-021-02845-x

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