Role of Biliary Brush Cytology in Primary Sclerosing Cholangitis

Utility of Bile Duct Brushings for the Early Detection of Cholangiocarcinoma in Patients With Primary Sclerosing Cholangitis

“…Although it is premature to extrapolate these observations to cytopathology specimens, a recent study of 21 patients showed that bile duct brushing, with use of consistent cytologic criteria, is a sensitive method of detecting neoplasia in the setting of PSC. 8 Our findings, in a larger cohort of patients, appear to support the hypothesis that serial bile duct brushings may be able to detect a significant number of patients with marked atypia and possibly concurrent early cancer.…”

“…Classification was based on accepted cytologic criteria, including nuclear membrane irregularity, chromatin irregularity, nuclear size, and nuclear/cytoplasmic ratio. 7,8 Atypical features were noted when cells contained enlarged, elongated nuclei, chromatin irregularities, and nuclear crowding within tissue fragments ( Figure 1). The atypical category was further qualified as focal (when the changes were seen in <25% of exfoliated cells) or marked (when the changes were present in >25% of exfoliated cells or when the cells harbored significant nuclear contour and chromatin irregularities, irrespective of extent of involvement).…”

Biliary Brush Cytology and the Detection of Cholangiocarcinoma in Primary Sclerosing Cholangitis

“…17 In addition, location of the malignant stricture has 19 Additional considerations include tumors that cause extrinsic compression without mucosal ulceration and sample collection during stent removal. 20 Our results are reassuring because they suggest that despite the reactive or inflammatory changes that occur in PSC, cytomorphologic criteria are still reliable and the inflammatory changes do not have a large negative effect on diagnostic accuracy when these criteria are applied.…”

Diagnostic benefit of biliary brush cytology in cholangiocarcinoma in primary sclerosing cholangitis

“…The corresponding specificity was 84%, implying the presence of some false-positive results. Reasons for the wide differences in sensitivity in brush cytology include variations in factors like sampling, quality of the cytological material, interpretation, and the expertise of the cytopathologist [8,19,24,25]. Our study was carried out prospectively with particular emphasis on obtaining adequate brush specimens, in some cases by repeat ERC.…”