85 research outputs found

    Histologic assessment of biliary obstruction with different percutaneous endoluminal techniques

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    BACKGROUND: Despite the sophisticated cross sectional image techniques currently available, a number of biliary stenosis or obstructions remain of an uncertain nature. In these pathological conditions, an "intrinsic" parietal alteration is the cause of biliary obstruction and it is very difficult to differentiate benign from malignant lesions using cross-sectional imaging procedures alone. We evaluated the efficacy of different endoluminal techniques to achieve a definitive pathological diagnosis in these situations. METHODS: Eighty patients underwent brushing, and or biopsy of the biliary tree through an existing transhepatic biliary drainage route. A subcoort of 12 patients needed balloon-dilatation of the bile duct and the material covering the balloon surface was also sent for pathological examination (balloon surface sampling). Pathological results were compared with surgical findings or with long-term clinical and instrumental follow-ups. Success rates, sensitivity, specificity, accuracy, confidential intervals, positive predictive value and negative predictive value of the three percutaneous techniques in differentiating benign from malignant disease were assessed. The agreement coefficient of biopsy and brushing with final diagnosis was calculated using the Cohen's "K" value. RESULTS: Fifty-six patients had malignant strictures confirmed by surgery, histology, and by clinical follow-ups. Success rates of brushing, balloon surface sampling, and biopsy were 90.7, 100, and 100%, respectively. The comparative efficacy of brushing, balloon-surface sampling, and biopsy resulted as follows: sensitivity of 47.8, 87.5, and 92.1%, respectively; specificity of 100% for all the techniques; accuracy of 69.2, 91.7 and 93.6%, Positive Predictive Value of 100% for all the procedures and Negative Predictive Value of 55, 80, and 75%, respectively. CONCLUSIONS: Percutaneous endoluminal biopsy is more accurate and sensitive than percutaneous bile duct brushing in the detection of malignant diseases (p < 0.01)

    Updated management of malignant biliary tract tumors: an illustrative review

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    The management of malignant biliary tumors (MBTs) is complex and requires a multidisciplinary approach. Guidelines and methods of staging for biliary tumors have recently been released by main international societies, altering the clinical and radiologic approach to this pathologic condition. The aim of the present review is to detail the updated role of imaging in preoperative staging and follow-up and to illustrate clinical/therapeutic pathways. In addition, future perspectives on imaging and targeted/embolization therapies are outlined

    Percutaneous endobiliary forceps biopsy of biliary strictures for histopathologic examination

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    PURPOSEWe aimed to investigate the feasibility, accuracy and safety of percutaneous endobiliary cholangio-forceps biopsy of biliary strictures in our institution.METHODSA total of 13 percutaneous transhepatic endobiliary biopsies (7 men and 6 women, mean age 66.85±16.76 years) were performed between January 2015 and March 2019 using a transluminal forceps biopsy device. Technical success, rate of complications, number of biopsy specimens, procedure and fluoroscopy time, mean radiation exposure were evaluated; sensitivity and accuracy were calculated.RESULTSTechnical success, i.e., acquisition of at least three (median, 3.00; range, 3–5) macroscopic representative samples, could be achieved in all 13 biopsies. Access was gained via the right liver lobe in 12 of 13 cases (92.3%). All patients presented blood work indicative of cholestasis prior the intervention, with mean bilirubin 4.72±3.72 µmol/L, mean γ-glutamyl transferase 574.16 ± 360.92 IU/L, and median alkaline phosphatase 407 IU/L (165–1366 IU/L). In 12 of 13 cases (92.3%), biopsied material was sufficient for the pathologist to make a histopathologic diagnosis. Analysis revealed cases of malignancy in eight of 13 cases (61.5%), all of which turned out to be cases of cholangiocarcinoma. In four benign cases (30.8%), diagnosis was considered to be confirmed by further imaging or clinical follow-ups, which showed no signs of progressive disease. There was one case (7.7%) of a false-negative result with proof of malignancy in subsequent surgical tissue extraction. A calculation of diagnostic performance yielded a sensitivity rate of 88.9% and an accuracy rate of 92.3%. There was one case of minor and one case of major complication in our study collective, leading to an overall complication rate of 15.4%.CONCLUSIONPercutaneous transhepatic biliary drainage (PTBD)-based forceps biopsy via the transhepatic drainage tract in patients with biliary obstruction of unknown origin is a technically feasible and safe technique with good diagnostic value rates. The procedure should be considered in patients not suitable for endoscopic strategies with indication for establishment of PTBD

    Hyperthermia Tissue Ablation in Radiology

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    British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma

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    These guidelines for the diagnosis and management of cholangiocarcinoma (CCA) were commissioned by the British Society of Gastroenterology liver section. The guideline writing committee included a multidisciplinary team of experts from various specialties involved in the management of CCA, as well as patient/public representatives from AMMF (the Cholangiocarcinoma Charity) and PSC Support. Quality of evidence is presented using the Appraisal of Guidelines for Research and Evaluation (AGREE II) format. The recommendations arising are to be used as guidance rather than as a strict protocol-based reference, as the management of patients with CCA is often complex and always requires individual patient-centred considerations

    Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging - IDKD Book

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    Gastrointestinal disease; PET/CT; Radiology; X-ray; IDKD; Davo

    Department of Radiology-Annual Report-July 1, 1990 to June 30, 1991

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    Department of Radiology Annual Report, July 1, 1990 to June 30, 1991. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States. 84 pages

    Department of Radiology-Annual Report-July 1, 1997 to June 30, 1998

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    Department of Radiology Annual Executive Summary Report, July 1, 1997 to June 30, 1998. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States. 103 pages
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