Superficial Epithelium in the Biopsied Sections Taken from Malignant Bile Duct Stenosis

Abstract

Abstract: Although percutaneous transhepatic cholangioscopy (PTCS) with biopsy is useful for the diagnosis of superficial spreading carcinoma of the bile duct, sections of biopsy specimens sometimes do not contain superficial epithelium. We sought to clarify the factors influencing the presence of superficial epithelium in biopsy specimens in a retrospective microscopic analysis of 168 hematoxylin and eosin‐stained sections of specimens from 54 patients with malignant bile duct stenosis. We correlated the presence of superficial epithelium with various factors using logistic regression analysis. Factors examined were whether the site was stenotic, the mucosal pattern at the biopsy site (papillo‐granular or smooth), specimen size, and whether the biopsy specimen was the first one taken at that same site. Bile duct tissues were present in 165 of 168 specimens (98%), and 93 (55%) contained superficial epithelium. By logistic regression analysis, mucosal pattern and order of biopsy at the same site were significantly related to presence of superficial epithelium on the histologic section (odds ratio with papillogranular mucosal pattern, 6.082; with first biopsy at the site, 2.628). Therefore, it is important to carefully choose biopsy forceps and to take multiple specimens at various sites to obtain superficial epithelium, especially with the smooth bile duct mucosal pattern.