Biliary stent–related alterations can be distinguished from adenocarcinoma on bile duct brushings using a limited number of cytologic features

Cytologic diagnosis of adenocarcinoma on bile duct brushings in the presence of stent associated changes: A retrospective analysis

“…Our data reveal that this degree of anisonucleosis can also be seen in a substantial number (100% in our study) of benign biliary strictures in the presence of a stent. Heath et al. also reported in their study that anisonucleosis, thus defined, was seen in 10 of 14 benign cases with stent and showed the weakest correlation with malignancy as compared with other cytologic features.…”

“…Our study revealed prominent nucleoli in 42% of benign cases, 65% malignant stented cases and 69% malignant non‐stented cases. Similarly, Heath et al reported macronucleoli in 12 of 15 malignant BDB and in 9 of 14 benign cases and did not find it to be a statistically significant distinguishing feature between the 2 . The higher proportion of prominent nucleoli in benign cases in the latter two studies is probably related to the fact that the negative cases were associated with a stent.…”

“…Several different cytologic features have reported to be useful in identifying malignant biliary strictures. One such feature that has been emphasized is the presence of two contrasting cell populations as opposed to a spectrum of cells with varying morphology . The latter is more compatible with reactive changes and is often seen in the setting of a stent.…”

“…The presence of “abnormal single cells”, “atypical single cells”, “single vacuolated malignant cells” or “cellular discohesion” has been reported to be one of the most important cytologic findings associated with malignancy in bile duct strictures . On logistic regression analysis, Fritcher et al found the presence of single abnormal cells in pancreatobiliary brushings to be an independent predictor of malignancy (76.9% in malignant vs 10.0% in benign samples).…”

“…Quite a few studies have addressed the difficulties in the interpretation of bile duct cytology in cases of primary sclerosing cholangitis. A recent study by Heath et al described the cytologic criteria for differentiating between stent‐related changes and malignancy in bile duct cytology. However, in our knowledge, no study so far has specifically examined the cytologic features of malignancy in the presence of a stent in BDB.…”