Diagnostic accuracy of Simpson atherectomy catheter biopsy in detecting pancreaticobiliary malignancy

OBJECTIVE: Impressive advances have been made in imaging the biliary tree by various modalities in the last few decades. However, the histological diagnosis of stenosing lesions in the biliary ductal system has remained difficult and unreliable. Application of Simpson atherectomy catheter biopsy in obtaining accurate histological diagnosis of bile duct lesions appears promising. The purpose of our study was to determine the clinical accuracy of the Simpson atherectomy catheter biopsy in the evaluation of bile duct strictures. METHODS: A retrospective study of medical records of patients who underwent bile duct biopsy by atherectomy catheter was conducted between 1991 and 1999. During this period, 53 patients underwent 56 endoluminal bile duct biopsies with an atherectomy catheter as part of an obstructive jaundice workup. Histological diagnosis on biopsy was confirmed by subsequent surgical biopsy and/or clinical follow-up. RESULTS: Fifty-four (96%) bile duct biopsies were technically successful in terms of yielding a histological diagnosis. Thirty-one of the 56 (55%) biopsy specimens were positive for malignancy (27 adenocarcinoma, two islet cell-carcinoids, one small cell carcinoma, and one malignant lymphoma). Four (7%) were read by the pathologist as highly suspicious for malignancy, and 19 (34%) specimens were considered negative for malignancy. Sensitivity of atherectomy catheter endoluminal biliary biopsy in this study was 97% with a specificity of 100%. In addition, the positive predictive and negative predictive values of this modality were 100% and 93%, respectively. CONCLUSIONS: Endoluminal bile duct biopsy by Simpson atherectomy catheter appears to be a highly sensitive and specific method for establishing histological diagnosis of stenosing lesions in the biliary ductal system.