Intraductal biliary biopsy: comparison of three techniques

J Vasc Interv Radiol. Sep-Oct 1996;7(5):743-50. doi: 10.1016/s1051-0443(96)70843-6.


Purpose: To compare the results obtained with three different techniques for percutaneous transhepatic intraductal biopsy.

Materials and methods: Eighty-eight patients with obstructive jaundice underwent placement of percutaneous biliary drainage catheters for biliary decompression. As part of the initial procedure or at a subsequent date, intraductal biliary biopsy (n = 109) was performed with use of one or more of three techniques including cytologic brush (n = 53), clamshell forceps under choledochoscopic guidance (n = 31), and clamshell forceps under fluoroscopic guidance (n = 25).

Results: Forty-eight patients (55%) had a final diagnosis of malignant disease, and 40 (45%) had a diagnosis of benign disease. One hundred six (97%) biopsy procedures yielded technically adequate specimens. No complications directly related to the biopsy procedures occurred. Overall sensitivity and specificity for each biopsy technique were 26% and 96% for the cytologic brush technique, 30% and 88% for the clamshell forceps under fluoroscopic guidance technique, and 44% and 100% for the clamshell forceps under choledochoscopic guidance technique, respectively. The sensitivities of the biopsy techniques for pancreatic carcinoma and cholangiocarcinoma, respectively, were 47% and 0% for brush; 75% and 0% for fluoroscopic clamshell; and 100% and 27% for choledochoscopic clamshell.

Conclusion: The choledochoscope-directed biopsy technique had the greatest sensitivity and specificity of the three techniques evaluated, but this difference was not statistically significant versus the brush or fluoroscopic clamshell technique (P > .10). The sensitivity of all three techniques for pancreatic carcinoma was significantly greater than that for cholangiocarcinoma. Multiple biopsies did not increase the overall sensitivity of intraductal biliary biopsy as a diagnostic technique. All three techniques proved to be safe and easy to perform.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / diagnosis
  • Bile Duct Neoplasms / pathology
  • Bile Ducts, Intrahepatic / pathology*
  • Biopsy / instrumentation
  • Biopsy / methods*
  • Carcinoma / diagnosis
  • Carcinoma / pathology
  • Catheterization / instrumentation
  • Child
  • Cholangiocarcinoma / diagnosis
  • Cholangiocarcinoma / pathology
  • Cholangiopancreatography, Endoscopic Retrograde / instrumentation
  • Cholangiopancreatography, Endoscopic Retrograde / methods
  • Cholestasis / therapy
  • Cytodiagnosis / instrumentation
  • Drainage / instrumentation
  • Female
  • Fluoroscopy
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / diagnosis
  • Pancreatic Neoplasms / pathology
  • Predictive Value of Tests
  • Radiography, Interventional
  • Sensitivity and Specificity