Biopsy of the Biliary Tract

Written by Brian Krans | Published on August 15, 2012
Medically Reviewed by George Krucik, MD

What is a Biliary Tract Biopsy?

Your biliary tract is the path through which the bile secreted from your liver is transported to the first part of the intestine, called the duodenum.

A biliary tract biopsy is the surgical removal of tissue or cells from the tract. After the sample is removed, doctors will test it in a laboratory for cancer or other potential problems.

Why a Biopsy of the Biliary Tract Is Done

A biopsy of the biliary tract is performed to investigate symptoms that could be related to problems with the biliary tract, such as stomach pain, or if imaging tests—such as CT scans and X-rays—show abnormal growths.

If you have been experiencing several symptoms—such as stomach pain and/or a yellowing of the skin and eyes—and your doctor has located an area of concern, he or she may order a biopsy to help determine if that area has been stricken by cancer.

A biopsy is the only sure way to diagnose cancer. Imaging tests can show that something is not normal, but they cannot differentiate between cancerous and noncancerous cells.

The biliary tract biopsy will allow your doctor to determine:

In some cases, your doctor might perform a surgery without first doing a biopsy. If the imaging tests showed a tumor in the bile duct, your surgeon may decide to treat the tumor as cancerous and remove it surgically right away, skipping the biopsy stage.

The Risks of a Biopsy of the Biliary Tract

Biopsies, in general, are low-risk procedures.

However, there is a risk of bleeding and infection at the incision site whenever a surgical incision is made.

How to Prepare for a Biopsy of the Biliary Tract

The preparation for a biliary tract biopsy depends on the type of biopsy being performed. Typically, your doctor will ask that you fast for eight to 12 hours before the procedure.

Your doctor will give you complete instructions, specific to your case. It’s important that you follow them exactly.

How a Biopsy of the Biliary Tract Is Performed

There are several ways to perform a biopsy on the biliary tract. In all procedures that involve breaking the skin, you will be given local anesthesia to numb any pain.

Cholangiography

This is not actually a biopsy. For this test, contrast dye is injected into the bile duct, so that it shows up better under an X-ray. In some cases, however, your doctor will perform a biopsy at the same time as a cholangiography. For the biopsy, your doctor will collect a tissue or fluid sample using a thin needle.

Biliary Brushing

In order to collect the sample, a tiny brush is fitted inside a thin needle or endoscope, which is a small tube inserted into the body through an incision. The biliary brush gently scrapes cells and tissue fragments from the bile duct lining for testing.

Needle Biopsy

The most common type of needle biopsy is called a fine needle biopsy. As the name indicates, a fine needle is used with a syringe to extract cells.

Sometimes the fine needle biopsy doesn’t work. Your doctor will then upgrade to a larger needle. This is known as a core needle biopsy. The core needle biopsy takes a larger sample of cells. This type of biopsy may be used if there is a tumor or cyst present in the biliary tract.

Endoscopic Retrograde Cholangiopancreatography

This long-named procedure involves threading a thin tube in through your mouth and down into the duodenum (a section of your small intestine). A catheter then goes into the tube to extract a sample from the ducts of the intestines.

Interpreting the Results of the Biopsy

Your doctor or a lab technician will look at the samples collected under a microscope. The results will usually be ready in a few days.

Normal results are an indication that your biliary tract is free of cancer, infection, and disease.

Abnormal results could mean you have cancer in your liver or pancreas. It could also mean you have another condition, such as primary sclerosing cholangitis, inflammation, or scarring of the bile ducts.

Your doctor may want to perform follow-up tests to isolate the problem. These could be blood tests or additional imaging tests and surgical procedures. Once the cause of your symptoms—whether it is cancer or another condition—has been identified, you and your doctor can begin a treatment to return you to health.

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