Tissue sampling from the common bile duct through endoscopic retrograde cholangiopancreatography, endoscopic papillo(sphinctero)tomy and drainage in juxtapapillary malignancies

Abstract

In 22 patients with radiological evidence of a malignant stricture or an obstruction of the common bile duct, endobiliary tissue specimens were obtained through endoscopic retrograde cholangiopancreatography. An endoscopic papillo(sphinctero)tomy was necessary in 9 of the 22 patients. The following techniques were employed: (1) forceps biopsy of the papillary infundibulum and/or of the common bile duct; (2) brush cytology in the same sites as above; (3) biliary juice cytology obtained by a nasobiliary drainage tube. In 8 patients, two different sampling techniques were used. The final diagnosis was established by means of pathological evaluation of surgical or necroscopic material. The diagnostic adequacy was 100% for biopsy, 88% for brush cytology, and 62% for bile cytology. The sensitivity was 100%, 66%, and 25%, respectively, for the above techniques. From 6 cases without biliary cancer, the specificity was 100%. These data show that biopsy specimens alone provide a definitive preoperative diagnosis in most cases, provided adequate samples are obtained.

Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis

“…There were 2 studies by the same group. 20,21 However, there was no overlap between the 2 studies, and hence both were included in our analysis.…”

“…19 Duct infiltration by the tumor, multiple large biopsy specimens, and excessive biliary dilation are independent risk factors for perforation. 18,20,21 …”

Differential diagnosis of intrahepatic bile duct dilatation without demonstrable mass on ultrasonography or CT: Benign versus malignancy

“…Furthermore, tumor masses are often not identifiable by CT, US or MR. Endoscopic approaches are also of limited use in tissue diagnosis because of the desmoplastic nature of these cancers. Indeed, bile cytology obtained by endoscopic retrograde cholangiography has a sensitivity of only 30–50%, 15–18 endobiliary brush cytology 50–66% 19,20 and endoscopic transpapillary biopsy 53–86% 9,21 , 22 for detecting cholangiocarcinoma. Because of problems involved in obtaining a tissue diagnosis, treatment and management decisions for patients with biliary strictures that might be malignant are problematic.…”

Biliary stent replacement cytology

“…Endobiliary brush cytology, first introduced by Osnes et al in 1975, 13 generally provides samples of greater cellularity resulting in a more consistent sensitivity ranging between 50 and 66%. [13][14][15] Endobiliary brush cytology is highly specific with only one false positive result reported in the English literature. 9 In this study, there were 24 patients, 10 of whom had malignancy.…”