Fine needle aspiration under percutaneous transhepatic cholangiographic guidance

Fine needle aspiration (FNA) is a rapid diagnostic technique accompanied by minimal patient morbidity and providing access to deep visceral lesions. We report three cases of obstructive jaundice secondary to malignancy in which FNA was performed at the time of percutaneous transhepatic cholangiogram. After the cholangiogram was performed and the obstructive lesion identified, a drainage catheter was inserted for decompression of the biliary tree. Using the drainage tube as a guide, multiple FNAs of the area of obstruction were done. In case 1 an area adjacent to the common bile duct was aspirated and diagnosed as adenocarcinoma of undetermined origin. FNA of a liver mass in case 2 revealed poorly differentiated squamous carcinoma consistent with a previous uterine cervix biopsy. Both of these patients were discharged for outpatient treatment following the procedure. In case 3 FNA diagnostic of adenocarcinoma was obtained from an intra- and extrahepatic mass. This patient underwent exploratory laparotomy for possible resection; adenocarcinoma of the head of the pancreas was found. For patients with advanced malignancies, minimizing inpatient hospital time is an important goal. In cases of obstructive jaundice secondary to malignancy, the combined techniques of percutaneous cholangiogram, biliary tree compression and FNA provide both diagnosis and palliation, with minimal morbidity and inpatient care.