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Biliary involvement in liver metastases: long-term experience with biliary biopsy from a single center / Envolvimento biliar nas metástases hepáticas: experiência a longo prazo com biópsia endobiliar em um único centro
Inchingolo, Riccardo; Nestola, Massimiliano; Department of RadiologyNunes, Thiago Franchi; Spiliopoulos, Stavros; Nardella, Michele.
  • Inchingolo, Riccardo; Madonna delle Grazie Hospital. Department of Radiology. Division of Interventional Radiology. Matera. IT
  • Nestola, Massimiliano; Madonna delle Grazie Hospital. Department of Radiology. Division of Interventional Radiology. Matera. IT
  • Department of RadiologyNunes, Thiago Franchi; Universidade Federal de Mato Grosso do Sul. Hospital Universitário Maria Aparecida Pedrossian. Department of RadiologyNunes, Thiago Franchi. Campo Grande. BR
  • Spiliopoulos, Stavros; National and Kapodistrian University of Athens. School of Medicine. 2nd Radiology Department. Athens. GR
  • Nardella, Michele; Madonna delle Grazie Hospital. Department of Radiology. Division of Interventional Radiology. Matera. IT
Radiol. bras ; 54(1): 15-20, Jan.-Feb. 2021. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1155233
ABSTRACT
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.
RESUMO
Resumo

Objetivo:

Investigar os resultados a longo prazo da biópsia endobiliar realizada com um pinça tipo fórceps transluminal no diagnóstico de neoplasia biliar metastática.

Materiais e Métodos:

Entre setembro de 2014 e junho de 2019, 25 pacientes - 18 homens (72%), com idade média de 65 ± 15 anos) - foram submetidos a 26 procedimentos de biópsia endobiliar com um conjunto dedicado. Todos os pacientes apresentaram icterícia obstrutiva, suspeita de malignidade e colangiorressonância pré-procedimento. Os procedimentos foram realizados durante o posicionamento percutâneo da drenagem biliar interna-externa, sob orientação fluoroscópica.

Resultados:

A taxa de sucesso técnico foi de 96% (25 casos), com diagnóstico histológico de estenose benigna (inflamatória) em cinco casos, adenocarcinoma pancreático em seis casos, metástases hepáticas retais no cólon em oito casos, carcinoma hepatocelular em três casos e de mucosa biliar normal em três casos. Em um caso a amostra foi considerada insuficiente pelo patologista (um adenocarcinoma pancreático) e o procedimento foi repetido com sucesso. O seguimento de 6 a 48 meses mostrou cinco casos falso-negativos, em particular dois casos de metástases hepáticas retais sem cólon (câncer de mama e gástrico) e três linfonodos hilares metastáticos. A análise estatística revelou sensibilidade de 77%, especificidade de 100% e precisão geral de 80%. A taxa de complicações foi de 11,5% (três casos com hemobilia transitória).

Conclusão:

A biópsia biliar transluminal realizada com pinça tipo fórceps é um procedimento minimamente invasivo, seguro e eficaz para caracterização histológica em pacientes que apresentam icterícia obstrutiva no diagnóstico de neoplasia biliar metastática.


Full text: Available Index: LILACS (Americas) Type of study: Practice guideline / Prognostic study Language: English Journal: Radiol. bras Journal subject: Diagnostic Imaging / Radiology Year: 2021 Type: Article Affiliation country: Brazil / Greece / Italy Institution/Affiliation country: Madonna delle Grazie Hospital/IT / National and Kapodistrian University of Athens/GR / Universidade Federal de Mato Grosso do Sul/BR

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Full text: Available Index: LILACS (Americas) Type of study: Practice guideline / Prognostic study Language: English Journal: Radiol. bras Journal subject: Diagnostic Imaging / Radiology Year: 2021 Type: Article Affiliation country: Brazil / Greece / Italy Institution/Affiliation country: Madonna delle Grazie Hospital/IT / National and Kapodistrian University of Athens/GR / Universidade Federal de Mato Grosso do Sul/BR