Biliary papillomatosis: correlation of radiologic findings with percutaneous transhepatic cholangioscopy

To correlate the radiologic findings with percutaneous transhepatic cholangioscopy (PTCS) in patients with pathologically confirmed biliary papillomatosis.

Thirteen patients diagnosed with pathologic papillomatosis or intraductal papillary neoplasms of the bile ducts were retrospectively reviewed. The imaging results from ultrasonography, multi-detector computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP) and percutaneous cholangiography (PTC) were correlated with the findings of PTCS.

Papillary neoplasms of the bile ducts usually appeared on ultrasound as a non-shadowing echogenic mass (60%) within dilated bile ducts. Localised dilatation of the bile duct with mild enhancing nodularities was the most common multi-detector CT finding (61.5%), followed by localised biliary dilatation with mild wall thickening (15.4 %). MRCP showed that the bile duct was locally dilated and filled with material of intermediate signal intensity (60%). An abnormal filling defect (71.4%) was the most common finding when PTC was used. In six patients who underwent PTCS, underlying fish egg-like intraluminal nodularities were noted with or without multifocal cauliflower-like papillary masses. In nine cases, the pathologic finding was intraductal papillary cholangiocarcinoma in the underlying biliary papillomatosis. Three patients were diagnosed as papillomatosis with high grade dysplasia and one as villous adenoma with underlying papillomatosis.

Imaging is useful for detecting bile duct tumours that cause obstruction, but its ability to detect fine features of intraductal papillary tumours is limited. Percutaneous transhepatic cholangioscopy is an effective approach that allows the direct visualisation and tissue confirmation of growing papillary tumours.