Biopsy - biliary tract

• Alternative Names

  Cytology analysis - biliary tract

• How the test is performed

  Tissue or material samples can be obtained in several ways, depending on the problem.

  If there is a well-defined tumor, the sample can be taken through an aspiration needle. The puncture site will be numbed. Then the needle is inserted through the skin into the lining or tissue to be tested. 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 continues.

  If there is a problem such as a narrowing (stricture) or blockage of the bile ducts or pancreatic ducts, a sample can be taken during procedures such as:

  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Percutaneous transhepatic cholangiogram (PTCA)

  If the sample is taken during the ERCP, an endoscope is passed through the mouth into the duodenum. A catheter is inserted through the endoscope and into the bile duct, and the sample is obtained. If a narrowing or blockage is observed, the area will be brushed. Then the sample of the brushed material will be analyzed.

  If a PTCA is performed, the puncture site will be numbed. The needle will be inserted through the skin into the ducts. A catheter will then be inserted to take a sample from the ducts.

• How to prepare for the test

  You may not be able to eat or drink 8-12 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 cause weakness. The health care provider will take your medical history and will examine you to determine the problem.

  For infants and children:

  The preparation you can provide for this test depends on your child's age and experience. For specific information regarding how you can prepare your child, see the following:

  • 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)
  • School age 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, you will feel a slight stinging sensation when the skin numbing medicine (local anesthetic) is injected. Even after the anesthetic takes effect, you may feel a cramping or pinching sensation during the procedure.

  If the specimen is taken during an ERCP, you will receive a spray to help numb your throat. You will also receive sedation and pain medications through a vein (IV). As a result, you should not feel much discomfort during the procedure.

• Why the test is performed

  A biopsy can determine whether a tumor started in the liver or spread from another location. It also can determine if a growth is cancerous.

  A biopsy may also be taken:

  • After a doctor's examination, x-ray, MRI, CT scan, or ultrasound has revealed abnormal growths
  • To test for diseases or infection
• Normal Values

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

• What abnormal results mean
  • Cancerous liver tumors (those that either started in the liver or spread to it)
  • Cholangiocarcinoma
  • Liver cysts
  • Pancreatic cancer
  • Primary sclerosing cholangitis
• 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.

• References
  Afdahl NH. Diseases of the gall bladder and bile ducts. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 159.

Review Date: 3/5/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.