Percutaneous transhepatic cholangiography versus endoscopic retrograde cholangiography for the pathological diagnosis of suspected malignant bile duct strictures

Abstract

To compare the diagnostic performance of percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography for the pathological assessment of suspected malignant bile duct stricture, using brush cytology and forceps biopsy. The study group comprised 79 consecutive patients who underwent pathological assessment for suspected malignant biliary stricture, 38 of whom underwent percutaneous transhepatic cholangiography (group A) and the other 41 underwent endoscopic retrograde cholangiography (group B). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. A subset analysis was performed to determine the effect of location and pathological type of the stricture on diagnostic performance, and complications were analyzed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86.7%, 100%, 100%, 66.7%, and 89.5%, respectively, in group A, and 77.1%, 100%, 100%, 42.9%, and 80.4%, respectively, in group B. For hilar biliary strictures, the sensitivity and accuracy were superior in group A than in group B. Mild complications (transient c and bile leakage) were identified in 7 cases in each group, all resolved spontaneously within 3 to 5 days. Both brush cytology and forceps biopsy performed during percutaneous transhepatic cholangiography and endoscopic retrograde cholangiography provided good diagnostic sensitivity and accuracy. Therefore, both diagnostic approaches can play an important role in planning therapeutic strategy. However, for strictures located at the hilum, pathology sampling via percutaneous transhepatic cholangiography is preferable to endoscopic retrograde cholangiography, as it provides higher sensitivity and accuracy.

Bile-Based Cell-Free DNA Analysis Is a Reliable Diagnostic Tool in Pancreatobiliary Cancer

“…In a recent prospective randomized trial, liquid-based or smear cytology of EUS-FNA obtained from solid pancreatic masses reached a sensitivity of 88% and 83.8%, respectively, for the diagnosis of pancreatic cancer [ 28 ]. Brush cytology and forceps biopsies displayed an overall sensitivity of 77.1% for the diagnosis of suspected malignant biliary strictures when obtained by ERC(P) [ 29 ]. Our results are in line with the previous studies, which reported high sensitivity and specificity of bile cfDNA analysis in gallbladder cancer and cholangiocarcinoma [ 30 , 31 ] and showed its value as ancillary method in the diagnosis of malignant biliary strictures [ 32 ].…”

Antegrade Endobiliary Forceps Biopsy Improves Diagnosis of Klatskin Tumor Compared to Brush Biopsy

“…Браш-биопсия обладает меньшей чувствительностью и показателем точности. При цитологическом исследовании у большинства пациентов невозможно оценить дифференцировку опухолевого процесса из-за забора небольшого объема ткани [18][19][20]. В нашем центре после браш-биопсии высокодифференцированная аденокарцинома обнаружена в одном, умеренно дифференцированная -в двух случаях, что соста-вило лишь 12,5 %.…”

“…Число больных Браш-биопсия, % Щипцовая биопсия, % Комбинация, % Tapping (2012) [22] 31 87 94 -Boots (2017) [12] 129 40,6 42,7 55,8 Tibana (2019) [19] 18 -94,4 -Augustin (2020) [18] 13 -88,9 -Chang (2020) [20] 79 Метод щипцовой биопсии не является совершенным. Так, например, при неизменной внутренней стенке протока необходимо выполнять биопсию через слизистую оболочку, что ухудшает результаты морфологического исследования [21].…”

“…H.-Y. Chang et al (2020) сравнивали результаты браш-и щипцовой биопсии при транспеченочном (n = 38) и эндоскопическом доступах (n = 41). Осложнения средней степени тяжести в виде транзиторной гемобилии и подтекания желчи были отмечены у 18 и 17 % пациентов соответственно, не требовали хирургического вмешательства и купировались на 3-5-е сутки [20].…”

Improving rehabilitation and quality of life after percutaneous transhepatic cholangiography drainage with a rapid rehabilitation model

“…Postoperative rehabilitation is important for patients with trauma and strengthening nursing measures can improve the speed of recovery[ 6 ]. Thus, the comprehensive treatment and nursing protocols implemented in the rapid rehabilitation nursing model have been well-received by most patients.…”