A bronchobiliary fistula (BBF) is a rare abnormal communication between the biliary tree and bronchial system. The majority of cases are the result of biliary obstruction or injury, with the major symptomatology of cough and biliptysis. The initial management of BBFs is variable but aims to decompress the biliary system allowing for diversion and passive healing of the fistula tract. Definitive management is with surgical fistulectomy. New minimally invasive therapeutic approaches utilizing endoscopic or percutaneous methodology have been described with some success. We present the successful treatment of a BBF that developed secondary to chemotherapy-induced biliary stricturing (CIBS) with a novel percutaneous embolization approach using a vascular plug and liquid embolic agent.

of a known primary malignancy, whereas the majority of patients with no known malignancy a new primary malignancy was diagnosed. Reference 1. Souza FF, Mortelé KJ, Cibas ES, Erturk SM, Silverman SG. Predictive value of percutaneous imaging-guided biopsy of peritoneal and omental masses: results in 111 patients. AJR Am J Roentgenol 2009; 192(1):131-136. http://dx. Purpose: Both bile cytology and pBB are limited by low sensitivity. In select cases we have used percutaneous cholangiographic guidance for pFNA to establish a diagnosis. We report the diagnostic rates of pBB and pFNA at a cancer center. Materials: Retrospective analysis of bile duct biopsies performed between January 2000 and January 2015, excluding patients without follow-up. Demographic data, biopsy results and clinical follow-up was obtained by review of the electronic medical record (EMR). Catheter cholangiography is performed and using fluoroscopic guidance a 20G or 22G needle is directed into the stricture and samples are obtained for pFNA. Quick Giemsa stain is performed by a cytotechnologist to assess adequacy and needle rinse for cell block collected. At the time of biliary drainage, or subsequent catheter exchange, pBB is performed by advancing a 6 Fr brush across the stricture and moving it back and forth, scraping the stricture. Material collected is then evaluated by quick Giemsa stains, and the brush and adherent cells are sent to pathology for creation of a cell block. Biopsy results were categorized as true positive (TP), true negative (TN), false positive (FP) and false negative (FN) based on pathology reports and confirmed by surgical specimens or clinical follow up. Fisher's exact test was used to compare the rate of TP in pFNA and pBB. Results: 119 patients underwent pFNA or pBB. 15 patients were excluded due to no follow up; we included 104 patients who underwent 117 biopsies, 34 pFNA and 83 pBB. There were no complications associated with pFNA or pBB. Sensitivity was 73% and 44% for pFNA and pBB respectively. In the pFNA group, 22/34 (64%) biopsies were diagnostic of malignancy, 4/34 (12%) were TN biopsies and there were 8 (24%) FN biopsies. In the pBB group, there were 20/83 (24%) samples diagnostic of malignancy, 38/83 (46%) TN biopsies and 25/83 (30%) FN biopsies. There were no FP biopsies in either group. The rate of TP was significantly higher in the pFNA group (p ¼ 0.0001) Conclusions: pFNA of bile duct strictures has better sensitivity than pBB and should be considered part of the IR armamentarium when the cause of a biliary stricture is in doubt.