Biliary involvement in liver metastases: long-term experience with biliary biopsy from a single center

Abstract Objective: To investigate long-term results of biliary biopsy performed with transluminal forceps in the setting of metastatic biliary involvement. Materials and Methods: Between September 2014 and June 2019, 25 patients-18 males (72%)-with a mean age of 65 ± 15 years, underwent 26 biliary biopsy procedures with a dedicated forceps system. All patients presented with obstructive jaundice that was suspected of being malignant and underwent pre-procedural magnetic resonance cholangiopancreatography. The biopsies were performed during percutaneous placement of an internal-external biliary drainage catheter, under fluoroscopic guidance. Results: The technical success rate was 96% (corresponding to 25 of the 26 procedures). The histological diagnosis was inflammatory biliary stricture in five cases, pancreatic adenocarcinoma in six, liver metastases from colorectal cancer in eight, and hepatocellular carcinoma in three, the biliary mucosa being categorized as normal in three cases. In one case, the sample was considered insufficient and the procedure was successfully repeated, after which a diagnosis of pancreatic adenocarcinoma was made. Over a follow-up period of 6-48 months, there were five false-negative results: two findings of inflammatory biliary stricture were later identified as liver metastases from breast and gastric cancer, respectively; and all three patients in which the biliary mucosa was categorized as normal were subsequently diagnosed with metastatic hilar lymph nodes. The procedure was found to have a sensitivity of 77%, a specificity of 100%, and an overall accuracy of 80%. The complication rate was 11.5% (mild, transient hemobilia occurring in three cases). Conclusion: Percutaneous transluminal forceps biopsy is a safe, effective, minimally invasive procedure for histological characterization in patients presenting with obstructive jaundice due to a non-primary biliary tumor.

摘要 目的：探讨经腔钳（transluminal forceps）活检用于胆道转移性累及场景时的长期应用效果。
材料与方法：2014年9月至2019年6月期间，共纳入25例患者（其中男性18例，占比72%），平均年龄为65±15岁，共计完成26次采用专用钳取系统的胆道活检操作。所有患者均表现为疑似恶性的梗阻性黄疸，且术前均接受了磁共振胰胆管造影（magnetic resonance cholangiopancreatography）检查。活检操作在透视引导下，于经皮放置内外引流胆道导管的过程中进行。
结果：技术成功率达96%（26次操作中成功25次）。组织病理学诊断结果如下：炎症性胆道狭窄5例、胰腺腺癌6例、结直肠癌肝转移8例、肝细胞癌3例，另有3例胆道黏膜被归类为正常。1例患者的活检样本被认定为取材不足，后续成功重复操作，最终确诊为胰腺腺癌。在6~48个月的随访周期内，共出现5例假阴性结果：2例最初诊断为炎症性胆道狭窄的患者，后续分别被确诊为乳腺癌肝转移与胃癌肝转移；3例初始胆道黏膜被归类为正常的患者，后续均被诊断为转移性肝门淋巴结癌。该操作的灵敏度为77%，特异度为100%，总体准确率为80%。并发症发生率为11.5%，3例患者出现轻度、一过性胆道出血（hemobilia）。
结论：经皮经腔钳取活检是一种安全、有效且微创的操作手段，可用于非原发性胆道肿瘤所致梗阻性黄疸患者的组织病理学定性诊断。