Cytodiagnosis in the management of extrahepatic biliary stricture.

Abstract

Aspirates were obtained by introducing a 9 cm 22 gauge spinal needle connected to a 20 ml syringe into the area of the stricture, after accurate localisation, and applying suction while oscillating the needle for a few millimetres in its long axis within the lesion. At least two passes were made on each patient. Specimens were handled immediately by a cytology technician. Fine needle aspiration specimens were expressed onto glass slides and bile and cytology brushings were smeared directly on to slides. The slides were either fixed immediately in 95% alcohol solution and later stained by the Papanicolaou method or air dried and stained with the MayGrunwald-Giemsa stain. The syringe was then rinsed with Eagle's medium, centrifuged, and cytospin preparations made. Some smears were stained with the periodic acid-Schiff reagent with and without diastase digestion to identify mucin production. The slides were examined by two trained pathologists and coded as unsatisfactory (acellular), negative, highly suspicious for malignancy, or definitely positive.

Usefulness of p53 gene mutations in the supernatant of bile for diagnosis of biliary tract carcinoma: comparison with K- ras mutation

“…However, due to cell injury and degradation induced by various proteases present in the bile juice, the accuracy of cytology for the diagnosis of BTCa has not been satisfactory. 2,3 In this series, we detected p53 mutations in 50% of bile samples from BTCa patients, but no p53 mutations were detected in the samples from patients with benign biliary diseases. Furthermore, p53 mutations, with high cancer specificity, were detected in 6 of 15 (40%) BTCa patients in whom bile cytologic diagnosis was negative, and 2 of these patients demonstrated p53 mutations alone.…”

“…Although some skillful cytologists have reported relatively high positive rates in BTCa, the accuracy of bile cytology for the diagnosis of BTCa has been limited, due to cell injury and degradation induced by various proteases present in bile juice. 2,3 Thus, analyses of cancer-related genes in bile for the specific diagnosis of BTCa have been anticipated. Only a few researchers have tried to analyze p53 or K-ras mutations in bile from patients with biliary malignancy, 4,5 but the usefulness of p53 or K-ras genetic analyses seems to be limited because of insufficient sensitivity or false positivity.…”

Contribution of Nuclear Morphometry by Confocal Laser Scanning Microscopy to the Diagnosis of Malignant Bile Duct Strictures

“…Each nucleus was considered a separate case for the purposes of the statistical analysis. The mean NV (SD) was 114.6 (22.3) μm 3 for the benign cases and 133.0 (17.1) μm 3 for the malignant cases. The mean NSF (SD) was 1.1 (0.1) for the benign cases and 1.2 (0.1) for the malignant cases.…”

“…The normal values for CEA and CA 19-9 were 0-5 ng/mL and 0-37 ng/mL, respectively. After an overall median follow-up period of 8 months (range, , of the 33 initially undiagnosed cases, 14 patients were diagnosed with benign strictures, with a median follow-up period of 18 months (range, 14-26), and 19 patients had malignant strictures (11 cholangiocarcinomas and 8 pancreatic ductal adenocarcinomas), with a median follow-up period of 7 months (range, [3][4][5][6][7][8][9][10].…”

Intraductal biliary and pancreatic endoscopy: An expanding scope of possibility

“…Traditionally, ERCP may be of assistance in characterizing the stricture by providing tissue sampling; however, the low yield rates of ERCPbased methods for securing the pathologic diagnosis of malignancy has been demonstrated in multiple studies. The diagnostic yield is variable in the range of 35% to 70% [31][32][33][34][35][36][37][38][39][40][41][42][43] . Percutaneous transhepatic cholangioscopy (PTCS) and POCS have both been used to obtain visually guided biopsies.…”