Diagnosis of malignant obstructive jaundice by bile cytology: Results improved by dilating the bile duct strictures

Mohandas, K. M.; Swaroop, Vege Santhi; Gullar, S.U.; Dave, Umakant; Jagannath, P.; Desouza, L. J.

doi:10.1016/s0016-5107(94)70157-1

Cited by 63 publications

(37 citation statements)

References 17 publications

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“…This deserves further investigation. Bile cytology has been shown to have 73% sensitivity for the diagnosis of gallbladder cancer [33], and this should be considered in patients who undergo ERCP (endoscopic retrograde cholangiopancreatography) preoperatively.…”

Section: Radiologic Workupmentioning

confidence: 99%

Gallbladder cancer

Bartlett

2000

Semin. Surg. Oncol.

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Section: Radiologic Workupmentioning

confidence: 99%

Gallbladder cancer

Bartlett

2000

Semin. Surg. Oncol.

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“…Techniques to improve diagnostic yield include repeated sampling or stricture dilatation [18]. The addition of fluorescence in situ hybridization, flow cytometry and digital imaging analysis to traditional cytologic evaluation have been studied in the past but have not been reported to improve overall accuracy [19,20,21].…”

Section: Discussionmentioning

confidence: 99%

Biliary Brush Cytology Revisited

Mehmood

Loya²,

Yusuf³

2016

Acta Cytologica

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Purpose: To evaluate the diagnostic yield of biliary brush cytology and the factors affecting positive results in patients with biliary strictures. Patients and Methods: The medical records of all patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary brush cytology at our institution from November 2004 to December 2013 were reviewed in this retrospective study. The yield of positive brush cytology and the factors affecting positive yield, such as stricture location, age, gender and preprocedure CA 19.9 level were assessed. The final histopathology, diagnosis obtained by other methods, such as endoscopic ultrasound-guided fine-needle aspiration cytology, CT scan, Tru-Cut biopsy and/or clinical/radiological follow-up were used to identify true- and false-positive/negative results. The brush cytology results were divided into 4 main categories: malignant, benign, atypical cells and inadequate. Results: A total of 1,168 patients underwent ERCP during this 9-year period. Out of these, 142 patients had ERCP and biliary brushings for diagnosis. The mean age of the patients at presentation was 58.7 years (range 23-84 years; 64.8% males). The indication for referral was obstructive jaundice in all patients. Of the 142 patients, 77 (54.2%) had a distal common bile duct (CBD) stricture and 65 (45.8%) had a proximal /complex hilar stricture. The strictures were classified as proximal or distal, based on their relationship with the cystic duct; those below the cystic duct insertion were classified as distal and those above it were considered proximal. The diagnostic yield of brush cytology was 58.5%. The diagnostic yield was higher for proximal than for distal CBD strictures (67 vs. 50%; p = 0.047). It was also higher for females (58 vs. 57.6%; p = 0.94), patients >50 years (60 vs. 50%; p = 0.29) and those with a CA 19.9 level >300 IU/ml (59.4 vs. 55.5%; p = 0.65) but did not reach statistical significance for any of these parameters. Complete follow-up data were available for 96 patients and 46 patients were lost to follow-up. The sensitivity, specificity, positive predictive value and negative predictive value were 65.3, 100, 100 and 27%, respectively. When patients with atypia were included in the group with positive results, the diagnostic yield increased to 65.5% with a diagnostic sensitivity of 68.6%. There were 27 false-negative diagnoses, 10 patients were true-negative and no patients had a false-positive diagnosis. Conclusion: Biliary brush cytology is a safe and simple initial diagnostic procedure in patients with biliary strictures and can be performed at the time of therapeutic ERCP. If performed correctly and then interpreted by a dedicated cytopathologist, it has a good diagnostic yield and sensitivity. We feel that the low rates of success with this technique reported in some earlier studies have led to a feeling that this is not a particularly useful technique. We recommend that this topic should be revisited, and that the technique should be used more often.

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“…MOHANDAS et al (16) demonstrated that dilating a malignant stricture using a 10 Fr catheter before bile aspiration enhanced cancer detection rate in comparison with a non dilation group (63.3% vs. 26.6%). Similarly, FARRELL et al (4) evaluated the sensitivity for malignancy of brush cytology after aggressive stricture manipulation by combined dilation up to 10 Fr and endoscopic needle aspiration.…”

Section: Discussionmentioning

confidence: 99%

Comparison between endoscopic brush cytology performed before and after biliary stricture dilation for cancer detection

Ornellas¹,

Santos

Nakao³

et al. 2006

Arq. Gastroenterol.

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-Background -Confirmation of malignancy within biliary strictures is endoscopically challenging. Dilation of strictures has been reported to enhance cytological diagnosis. Aim -To compare brush cytology results before and after biliary stricture dilation. Patients and Methods -Patients with extra-hepatic biliary stricture at endoscopic retrograde cholangiopancreatography were included in the study. Brushing was performed before and immediately after dilation using a 10 Fr dilating catheter. Cytology samples were classified as: negative for malignancy, presence of atypical cells, insufficient material, suspicious for malignancy or positive for malignancy. Final diagnosis was established by surgery, biopsy or followup. Results -Biliary brush cytology was performed in 50 patients, with an overall sensitivity of 40% and 27.5%, before and after dilation, respectively. The combination of results increased cancer detection rate to 45%. There were 5/50 (10%) minor complications and one death related to the procedure. Conclusions -Brush cytology performed before biliary stricture dilation has a similar cancer detection rate to that following dilation, although the combination of results enhances sensitivity.

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Diagnosis of malignant obstructive jaundice by bile cytology: Results improved by dilating the bile duct strictures

Cited by 63 publications

References 17 publications

Gallbladder cancer

Gallbladder cancer

Biliary Brush Cytology Revisited

Comparison between endoscopic brush cytology performed before and after biliary stricture dilation for cancer detection

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