The Relativity Study Of Biopsy During PTCD Between Pathologic And Imageologic Features

Background and purpose: Obstructive jaundice(OJ) can be caused by multiple etiology, which included benign and malignant disease. The benign disease can be treated by surgical or medical methods. Once the pathogeny is dispelled, the jaundice symptom will disappear very soon. While the malignant biliary stenosis can be very troublesome. Malignant biliary stenosis can be caused by cholangiocarcinoma, gallbladder carcinoma, pancreatic carcinoma, hepatoma, lymph metastasis, lymphoma and some other disease. Once the symptom of OJ presented, it had been the terminal stage in most cases, and lost the chance of surgical treatment. Because of the complex anatomic structure and little focus, it make it very difficult to ensure the orientation to get biopsy before operation, without pathologic diagnosis, the treatment may be aimless. As a result, the curative effect can be futile. Any treatment plan without pathologic diagnosis goes against the principles of evidence-based medicine.To solve the difficulty which has troubled the clinic for a long time, many non-operative biopsy methods have been put in practice to get pathologic diagnosis. But most of them has a low sensitivity and a high rate of syndrome, which can not make the clinic satisfied. Now, our study group and Jung in Korea employed a new non-operative method to solve the problem almost simultaneously, percutaneous transhepatic cholangiobiopsy (PTCB), which includes endobiliary forceps biopsy and endobiliary brush cytology. The technique has a high sensitivity and little extra trauma, and is veryeasy performing. In this study, we retrospectively analyze the imageing and clinical data of 84 patients with OJ who have been performed PTCB during the process of percutaneous transhepatic cholangiodrainage (PTCD). To discuss the influence of the different etiology of OJ and appearance of PTC (Percutaneous transhepaticcholangiography) and CT(Computed tomography) on the result of PTCB.Material and methods: From April 2001 to December 2003, all consecutive 84patients(male 49, female 35; aged 31-94, mean 65.85+0.17 ) with malignant OJ were reviewed who underwent PTCD, during which PTCB was attempted to ensure the final diagnosis of OJ. The data of clinical and imaging appearance was collected. Each patient presented with OJ, serum BIL and DBIL increased notably. All patients have the final diagnosis and 77 patients were diagnosed as malignant OJ.The technique of PTCD was performed with standard process. During the process endobiliary forceps biopsy and brushing was performed. In order to get enough tissue, multiple sites were nipped until obviously white tissue was gained; the brush was pulled and pushed with a to-and-fro movement, the cellular material adherent to the brush was transferred to a glass slide and immediately fixed for cytological examination. The positive result was regarded as the final diagnosis, while the negative result can not exclude the malignant diagnosis.The definitive diagnosis of OJ was ultimately established by three means. ㏒urgery with biopsy obtained from the stricture sites or original tumor around. 〣iopsy obtained from the bile duct by forceps or the cytological diagnosis from endobiliary brushing. Once neither of the results was positive, the final diagnosis can be induced by the third method. (3) Combination of methods including clinical, CT, ultrasomography, elevated carcimo-embryonic antigen levels, clinical course, and follow-up.Double-blind analysis method was adopted to analyze the imaging data. The content of SCT information included: (1)The shape and range of the lesion; (2)The invasion condition to the round tissue; (3)Metastasized to distance organ; (4) The feature of dynamic enhanced CT. The PTC information included: (1)The site of the lesion; (2)The length of the stenosis; (3)The dilatation grade of bile duct; (4)The configuration of the stenosis.Since the various biological doing of different original tumor, the different positiverate from cholangiocarcinoma and non-cholangiocarcinoma was fir...