J Korean Soc Radiol.  2016 Jan;74(1):1-7. 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

• Hong JH
• Ryeom H
• Jang YJ
• Kim GC
• Cho SH
• Song JH

• KMID: 2150456
• DOI: http://doi.org/10.3348/jksr.2016.74.1.1

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.

MeSH Terms

Bile
Bile Ducts
Biopsy*
Catheters
Cholangiocarcinoma
Cholangiography
Constriction, Pathologic*
Diagnosis
Dilatation*
Drainage*
Filtration
Follow-Up Studies
Hemobilia
Humans
Radiology, Interventional
Sensitivity and Specificity
Surgical Instruments

Figure

• 

  Fig. 1 Photograph of soft tissue fragments adherent to the retrieved balloon catheter and soft tissue components separated by gauze filtration of evacuated bile.

• 

  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.

• 

  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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