Endoscopic biliary tract brush cytology in 54 cases

Aim: Duct brushing cytology is an important tool in the evaluation of the extrahepatic biliary tract. New liquid-based preparations and ancillary tests have emerged with the intent of addressing this issue.Materials and methods: Fifty-four consecutive patients and 68 specimens with a suspected malignant obstruction of the common bile duct were included in a consecutive, nonrandomized order. We selected patients whose follow-up, in the form of either histology (25/54, 46%) or at least 6 months of clinical observation, was available. They underwent sampling during ERCP (33 patients/40 materials) or PTC (21 patients/28 materials) using the brush method. Results: A total of 68 specimens were identified from 54 patients. The cytologic findings were: 35% benign, 37% malignant, and 9% suspicious for malignancy. Overall operating characteristics were: 48% sensitivity, 100% specificity,100% positive predictive value, 69% negative predictive value, and 75% accuracy. For the diagnosis of malignant stenosis,the sensitivity was 48% for cytology, 60% for biopsies, and 50% for the combination of cytology and biopsies. In addition,the Cytospin method showed more cellularity compared with the other preparation method (n = 68 materials; 57%Cytospin, 38% direct smear).Conclusion: Diagnosis of malignant biliary stenosis may be improved by a combination of endobiliary sampling and cytology.