Multiple bile duct biopsies using a sheath with a side port: usefulness ofintraductal sonography

OBJECTIVE. We clarified the number of biopsies required to determine malign ancy of the biliary; tract on the basis of the type of bile duct tumor. SUBJECTS AND METHODS. patients with a biliary tract malignancy (n = 33) and a benign biliary stenosis (n = 3) underwent biopsy via the percutaneous tr anshepatic route. We performed intraductal sonography rising a 20-MHz probe with a 2.0-mm diameter. The sonographic findings were prospectively classi fied as polypoid. circular. or semicircular. The tip of a long 9-French she ath with a side port was wedged into the stenosis, and six specimens a ere obtained with a 1.8-mm-diameter forceps with serrated cups, RESULTS, When cholangiography or intraductal sonography showed a polypoid l esion, the sensitivity of two biopsies was 100% (6/6). When cholangiography showed a stenotic lesion, the sensitivity of nine biopsies (96%, 26/27) wa s superior to that of two biopsies (74%, 20/27; p < 0.05). When intraductal sonography showed a circular lesion, the sensitivity of three biopsies (10 0%. 14/14) was superior to that of a single biopsy (64%, 9/14: p < 0.05). W hen it showed a semicircular lesion, the sensitivity of nine biopsies (92%, 12/13) was superior to that of two biopsies (54%, 7/13: p < 0.05). CONCLUSION. Bile duct biopsy using a sheath with a side port has a high sen sitivity However. the number of biopsies required depends on the cholangios copic and intraductal sonographic appearance of the tumor.