The usefulness of percutaneous transhepatic cholangioscopy for identifying malignancies in distal common [corrected] bile duct strictures

Abstract

The diagnostic accuracy of percutaneous transhepatic cholangioscopy (PTCS) was compared to that of three radiologic modalities in distal common bile duct (CBD) strictures for the evaluation of clinical application. Ninety-five patients who underwent PTCS for the evaluation of distal CBD strictures (35 malignant and 60 benign) whose masses were not obvious from radiologic imagings were included. Confirmative diagnosis could not be reached by endoscopic retrograde cholangiopancreatography (ERCP) or radiologic findings in all cases. Specific findings on the computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and direct cholangiography were analyzed among 68 (25 malignant and 43 benign) out of the 95 patients in order to determine the sensitivity and specificity of three radiologic studies for the diagnosis of malignant distal CBD strictures, and to compare those results with those by a combination of PTCS-guided biopsy and tumor vessel observation on cholangioscopy. The sensitivity/specificity of CT, MRCP and direct cholangiography including ERCP in diagnosing malignant distal CBD strictures were 42.9%/65.8%, 53.3%/58.3%, and 70.8%/47.6% respectively, while it was 96%/100% for the combination of PTCS-guided biopsy and tumor vessel. PTCS is a useful method for differential diagnosis of distal CBD strictures, particularly when it is difficult to distinguish benign from malignant strictures by radiologic studies and when peroral approach is not feasible.

Fig. 1

Studies of a 59-yr-old male patient. While radiologic findings suggested a malignant distal common bile duct stricture, PTCS and biopsy findings revealed a benign stricture. (A) MRCP image showing abrupt and asymmetric narrowings. (B) ERCP image showing abrupt and asymmetric narrowings. (C) PTCS image showing no tumor vessel or mucosal abnormality.

Fig. 2

Studies of a 64-yr-old male patient. While radiologic findings suggested a benign stricture, PTCS imaging showed hyperemic mucosa and tumor vessels, and PTCS-guided biopsy data revealed an adenocarcinoma. (A, B) CT image showing no wall thickening or enhancement. (C) MRCP image showing gradual narrowing and symmetric narrowing. (D) Percutaneous transhepatic cholangiogram image showing gradual narrowing and smooth narrowing. (E) PTCS image showing hyperemic mucosa and tumor vessels in the distal common bile duct.