Usefulness of lavage cytology during endoscopic transpapillary catheterization into the gallbladder in the cytological diagnosis of gallbladder disease

Abstract

Many studies have reported methods of cell collection involving percutaneous transhepatic cholangiodrainage (PTCD) and fine-needle aspiration cytology for the diagnosis of gallbladder disease. However, few studies have described the use of a transpapillary approach, i.e., endoscopic transpapillary catheterization into the gallbladder (ETCG). In this study, we analyzed cells collected by ETCG to evaluate its usefulness in the cytological diagnosis of gallbladder disease. The subjects were 19 patients who had undergone ETCG for the diagnosis of gallbladder disease. Of these patients, 11 and 8 had gallbladder cancer and benign gallbladder disease, respectively. We also evaluated the diagnostic accuracy of PTCD cytology performed in 15 patients with gallbladder cancer.Specimens were cytologically diagnosed as normal or benign, indeterminate, suspected malignancy, malignant, and inadequate in 47% (9/19), 11% (2/19), 0% (0/19), 37% (7/19), and 5% (1/19) of patients, respectively. Specimens were diagnosed as malignant, indeterminate, normal or benign, and inadequate in 7, 2, 1, and 1, respectively, of the 11 patients diagnosed with gallbladder cancer. The sensitivity and specificity of ETCG cytology were 78 and 100%, respectively, whereas the diagnostic accuracy of PTCD cytology was 20% (3/15). None of the patients developed complications of ETCG. Despite its technical difficulty, ETCG for bile cytology allows the collection of adequate cell numbers from patients with benign disease or gallbladder cancer and facilitates a cytological diagnosis, making it a useful method for collecting cells.

Morphometric image analysis of pancreatic disease by ThinPrep liquid‐based cytology

“…TP smears were stained with Papanicolaou stain using routine laboratory protocol and were classified as inadequate, normal or benign, indeterminate, suspected malignancy, and malignant using the diagnostic criteria described in our previous report. 5…”

“…4 ERCP‐guided cytology, such as pancreatic juices, pancreatic brushing, and pancreatic washing, has common gained acceptance as a means of preoperative diagnosis of pancreatic disease, and this procedure is usually performed for cytological diagnosis in the pancreas and bile duct. 5, 6 The main disadvantage of using brushing cytology is human error, air‐drying artifacts, and cells being obscured by necrosis, inflammation, and red blood cells.…”

Endoscopic diagnosis of cystic lesions of the pancreas

“…In this meta‐analysis, lavage cytology improved the sensitivity to 45.8%. Lavage cytology has also been shown to be useful in diagnosing bile duct cancer and gallbladder diseases . Balloon catheters have been used for spot shooting of the desired area .…”

“…Lavage cytology has also been shown to be useful in diagnosing bile duct cancer and gallbladder diseases. 71,72 Balloon catheters have been used for spot shooting of the desired area. 73 In contrast, an evaluation of pancreatic juice cytology obtained by routine preoperative ERCP in 70 patients with IPMN found that the addition of pancreatic juice cytology altered treatment in two patients with branch-duct (BD)-IPMN from observation to surgical resection.…”

Cancer of the gallbladder

“…Gallbladder cancer has a tendency to seed the peritoneum, biopsy tracts, and surgical wounds (Fong et al, 1993;Hu et al, 2008;Merz et al, 1993), and unnecessary biopsies simply increase this risk. Sensitivity of bile cytology has been reported to be approximately 75% (Akosa et al, 1995;Arora et al, 2005;Mohandas et al, 1994;Naito et al, 2009). If the diagnosis is suspected, the surgeon and patient must be prepared for a definitive operation.…”