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

Abstract

-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.

Team approach to ERCP-directed single-brush cytology for the diagnosis of malignancy

“…However, although highly specific, ERCP-directed brush cytology is not very sensitive, due to a high rate of false-negative diagnoses (3,4,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Several ways have been proposed to overcome this limitation, such as: the use of a different procedure to prepare the brush samples (8); making more malignant cells available for cytopathologic evaluation by increasing the brushing cellular yielding (2,4,19,20); combining brush cytology with some others techniques (2,6,7,(21)(22)(23)(24)(25)(26). While the first two approaches are mostly ineffective, multimodal sampling can improve the sensitivity, although the simplicity that characterizes the ERCP-directed brush cytology is somehow lost.…”

Per-oral cholangioscopy

“…The diagnostic specificity of ERCP and brush cytology is very high but its sensitivity remains low despite modifications in the brush itself, balloon dilatation of the strictures prior to brushing or DNA methylation improves analysis of ERCP brush specimens. [21][22][23][24] In a study by Fukuda et al, when cholangioscopy was carried out in addition to ERCP for evaluation of biliary strictures or filling defects, it increased the diagnostic accuracy from 78% to 93% and sensitivity from 58% to 100% (Fig. 4A-C).…”

Techniques for cytologic sampling of pancreatic and bile duct lesions

“…Cytologic analysis of bile duct tissue provides a more accurate diagnosis than histologic processing of tissue . One study suggested that the sensitivity could be improved by dilating the stricture before bile acquisition, but significant complications have been reported . Repeated brushings will improve the diagnostic yield of biliary cytology .…”