Evaluation of percutaneous endobiliary punch biopsy in suspected malignant biliary strictures: Five-year experience from a tertiary center.

Abstract

Background and aim: To evaluate the diagnostic performance, technical feasibility, and safety of percutaneous endobiliary punch biopsy (PEPB) in patients with suspected malignant biliary strictures, particularly when endoscopic approaches are not feasible.

Materials and methods: This retrospective, single-center study included 23 patients with radiologically confirmed biliary strictures who underwent PEPB between January 2020 and January 2025. All procedures were conducted under fluoroscopic guidance following percutaneous biliary drainage. Clinical, laboratory, and procedural data were reviewed.

Results: Biopsy samples were adequate for histopathological analysis in all cases. The technical success rate was 100%. Malignancy was detected by PEPB in 17 patients, while 3 cases were confirmed as benign and 3 were false-negative results later proven malignant. PEPB demonstrated a sensitivity of 85%, specificity of 100%, and an overall accuracy of 86.96%. Fisher's exact test showed a significant association between biopsy results and final diagnosis (p=0.011). Two minor complications (8.7%)-cholangitis and hemobilia-occurred and were managed conservatively.

Conclusion: PEPB is a safe, technically viable, and diagnostically accurate method for tissue sampling in biliary strictures. It offers a valuable alternative when endoscopic biopsy fails or is not feasible.