Ierardi Anna Maria, Mangini Monica, Fontana Federico, Floridi Chiara, De Marchi Giuseppe, Petrillo Mario, Capasso Raffaella, Chini Claudio, Cocozza Eugenio, Cuffari Salvatore, Segato Sergio, Rotondo Antonio, Carrafiello Gianpaolo
Department of Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi , Varese , Italy.
Minim Invasive Ther Allied Technol. 2014 Mar;23(2):96-101. doi: 10.3109/13645706.2013.854807. Epub 2013 Dec 12.
To evaluate the usefulness and safety of percutaneous transluminal forceps biopsy in patients suspected of having a malignant biliary obstruction.
Forty consecutive patients (21 men and 19 women; mean age, 71.9 years) underwent forceps biopsy through percutaneous transhepatic biliary access performed to drain bile. Lesions involved the common bile duct (n 8), common hepatic duct (n 18), hilum (n 6), ampullary segment of the common bile duct (n 8) and were biopsied with 7-F biopsy forceps. Final diagnosis was confirmed with pathologic findings at surgery, or clinical and radiologic follow-up.
Twenty-one of 40 biopsies resulted in correct diagnosis of malignancy. Thirteen biopsy diagnosis were proved to be true-negative. There were six false-negative and no false-positive diagnoses. Sensitivity, specificity and accuracy in aspecific biliary obstructions were 85%, 100% and 88,7% respectively. Sensitivity of biopsy in malignancies was higher than in benign obstructions (100% vs 68,4%, CI = 95%). Sensitivity was lower in the hilum tract and in the common bile duct than in other sites (CI = 95%). No major complications related to biopsy procedures occurred.
Percutaneous transluminal forceps biopsy is a safe procedure, easy to perform through a transhepatic biliary drainage tract, providing high accuracy in the diagnosis of malignant biliary obstructions.
评估经皮腔内钳取活检术在疑似恶性胆管梗阻患者中的有效性和安全性。
连续40例患者（21例男性和19例女性；平均年龄71.9岁）通过经皮经肝胆道穿刺置管引流胆汁的途径接受钳取活检。病变累及胆总管（8例）、肝总管（18例）、肝门部（6例）、胆总管壶腹部（8例），并使用7F活检钳进行活检。最终诊断通过手术病理结果或临床及影像学随访得以证实。
40例活检中有21例确诊为恶性肿瘤。13例活检诊断为真阴性。有6例假阴性诊断，无假阳性诊断。在非特异性胆管梗阻中，敏感性、特异性和准确性分别为85%、100%和88.7%。活检对恶性肿瘤的敏感性高于良性梗阻（100%对68.4%，CI = 95%）。肝门部和胆总管部位的敏感性低于其他部位（CI = 95%）。未发生与活检操作相关的严重并发症。
经皮腔内钳取活检术是一种安全的操作，易于通过经肝胆道引流途径实施，在恶性胆管梗阻的诊断中具有较高的准确性。
