Diagnosis of bile duct cancer by bile cytology: usefulness of post-brushing biliary lavage fluid

Abstract

Background: Pathologic evidence of biliary diseases can be obtained from cytology in addition to endoscopic retrograde cholangiopancreatography (ERCP); however, the diagnostic effectiveness is not satisfactory. Study aim: This retrospective, single-center study evaluated the efficacy of various sampling methods for the cytologic diagnosis of bile duct cancer. Patients and methods: Biliary samples included bile that was simply aspirated, brush smear, brush-rinsed saline, and post-brushing biliary lavage fluid. A set of samples was compared for cytologic efficacy in 76 patients with surgically proven bile duct cancer and in 50 patients with benign biliary stricture. Results: The cytologic sensitivity for diagnosing biliary cancer was 34 % with aspirated bile, 32 % with brush smear, 43 % with brush-rinsed saline, and 70 % with post-brushing biliary lavage fluid, in contrast to the null false-positive result in the benign cases. The sensitivity of cytology was significantly higher with post-brushing lavage fluid than with the other three sampling methods (P < 0.0001), and post-brushing lavage fluid improved the cumulative sensitivity by 24 % (P = 0.002). The sensitivity of biliary cytology was also associated with the amount of aspirated bile (P = 0.01) and with the aspiration site (P = 0.03). The rate of cancer positivity in a cytology set differed according to the tumor macroscopic type (85 % in the protruding type vs. 40 % in the flat type; P = 0.003), and according to the size of the cancer (87 % for tumors ≥ 50 mm vs. 66 % for tumors < 50 mm; P = 0.02). Conclusions: Post-brushing biliary lavage fluid cytology provides superior diagnostic efficacy, and its addition to ERCP procedures is recommended for obtaining cytologic evidence of bile duct cancer.

Preoperative diagnosis of well‐differentiated neuroendocrine tumor in common hepatic duct by brush cytology: A case report

“…Because cholangiocarcinoma is the most common malignant tumor of the biliary tree (approximately 80% of cases), cytologic findings suspicious of malignancy include dyscohesive/loose three‐dimensional cell clusters, loss of honeycomb pattern characteristic of benign epithelium, increased N/C ratio, nuclear molding/indentation, nuclear enlargement and pleomorphism, coarse/clumped chromatin, irregular nuclear contours, macronucleoli, loss of nuclear‐cytoplasmic polarity, and necrotic background . However, the sensitivity for the diagnosis of biliary cancer is unsatisfactory although several ancillary techniques such as DNA histogram or fluorescence in situ hybridization of chromosomes 3, 7, 9, 17 have been applied to improve the yield of brush cytology. Sugimoto et al reported that the use of brush‐rinsed saline and postbrushing biliary lavage fluid improved the sensitivity by increasing the cellular component in the sample .…”

“…However, the sensitivity for the diagnosis of biliary cancer is unsatisfactory although several ancillary techniques such as DNA histogram or fluorescence in situ hybridization of chromosomes 3, 7, 9, 17 have been applied to improve the yield of brush cytology. Sugimoto et al reported that the use of brush‐rinsed saline and postbrushing biliary lavage fluid improved the sensitivity by increasing the cellular component in the sample . In addition, they described that the efficacy of cytology for detecting tumors is related to wider intramucosal tumor spread and intraluminal protruding tumor growth .…”

“…Sugimoto et al reported that the use of brush‐rinsed saline and postbrushing biliary lavage fluid improved the sensitivity by increasing the cellular component in the sample . In addition, they described that the efficacy of cytology for detecting tumors is related to wider intramucosal tumor spread and intraluminal protruding tumor growth . Therefore, the preoperative diagnosis of NET by brush cytology was reported to be almost impossible because NET usually show subepithelial growth .…”

“…The endobiliary brush cytology has been widely used for the preoperative diagnosis of biliary disease. 13 18 In addition, they described that the efficacy of cytology for detecting tumors is related to wider intramucosal tumor spread and intraluminal protruding tumor growth. 18 Therefore, the preoperative diagnosis of NET by brush cytology was reported to be almost impossible because NET usually show subepithelial growth.…”

Utility of lavage cytology plus targeted biopsy during cholangioscopy for the diagnosis of indeterminate biliary lesions

“…Balloon predilation was previously reported to significantly improve the diagnostic yield of BC [8]. Sugimoto et al [26] recently reported that the diagnostic efficacy of cytological evaluation of post-brushing biliary lavage fluid was superior to that of BC in bile duct cancer (75% vs. 49%). We predict that the effect of lavage followed by dilation/distortion by SpyGlass  might be comparable to that achieved by predilation or post-brushing lavage.…”