Biopsy - biliary tract

Alternative names
Cytology analysis - biliary tract

Definition
A procedure that involves taking a sample of tissue or material from the duodenum, bile ducts, pancreas or pancreatic duct to test for malignancy or other diseases.

How the test is performed

Depending upon the problem, specimens can be obtained in multiple ways. If there is a discrete mass, the specimen can be obtained through an aspiration needle. If the biopsy specimen is taken through a needle, the puncture site will be anesthetized and the needle inserted through the skin into the lining or tissue to be analyzed. A small amount of tissue is taken in through the needle, and the needle is removed. The puncture site is then covered to control any bleeding. Pressure may be applied to the puncture site if bleeding persists.

If there is an abnormality such as a stricture or blockage of the bile ducts or pancreatic ducts, a specimen can be taken during procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiogram (PTC).

If the specimen is taken during the ERCP, and endoscope is passed through the mouth into the duodenum. A catheter is inserted through the endoscope and into bile duct, and a specimen is obtained. If a stricture or blockage is observed, the area will be brushed, and the sample of the brushed material will be analyzed. If a percutaneous transhepatic cholangiogram (PTC) is performed, the puncture site will be anesthetized, and the needle will be inserted through the skin into the ducts. A catheter will then be inserted to obtain a specimen from the ducts.

How to prepare for the test
Food and fluids are restricted 8 to 12 hours or more before the test. Your health care provider will give you specific instructions. You must sign an informed consent form. Arrange transportation for yourself, because the procedure can induce weakness. Your medical history will be taken and a physical examination performed.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child’s age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child’s age:

     
  • infant test or procedure preparation (birth to 1 year)  
  • toddler test or procedure preparation (1 to 3 years)  
  • preschooler test or procedure preparation (3 to 6 years)  
  • schoolage test or procedure preparation (6 to 12 years)  
  • adolescent test or procedure preparation (12 to 18 years)

How the test will feel

If the biopsy is taken through a needle, there will be a slight stinging sensation when a local anesthetic is administered. After the anesthetic takes effect, there may be a cramping or pinching sensation.

If the specimen is obtained is taken during an ERCP, you receive a spray to help numb your throat. You also receive intravenous sedation and pain medications. As a result, there is generally minimal discomfort during the procedure.

Why the test is performed
A biopsy is necessary to distinguish between metastatic and primary tumors and to determine if a growth is malignant.

A biopsy may also be taken:

     
  • to test for diseases or infection  
  • after an X-ray, MRI, or ultrasound has revealed abnormal growths

Normal Values
Tissue that is not cancerous, diseased, or infected is normal.

What abnormal results mean

     
  • primary or metastatic hepatic neoplasms  
  • hepatic cysts  
  • pancreatic cancer  
  • cholangiocarcinoma

What the risks are
There is some risk of bleeding from the biopsy site. With the needle biopsy, there is a slight chance of infection at the puncture site. Also see the risks for an ERCP if the biopsy is taken through an endoscope.

Special considerations
This test is performed after a health history, physical examination, or other tests and procedures have indicated abnormal growths or signs of malignancy or disease.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.