Diagnosis of bile duct cancer by bile cytology: usefulness of post-brushing biliary lavage fluid

Background: Pathologic evidence of biliary diseases can be obtained from cytology in addition to endoscopic retrograde cholangiopancreatography (ERCP); however, the diagnostic effectiveness is not satisfactory. Study aim: This retrospective, single-center study evaluated the efficacy of various sampling methods for the cytologic diagnosis of bile duct cancer. Patients and methods: Biliary samples included bile that was simply aspirated, brush smear, brush-rinsed saline, and post-brushing biliary lavage fluid. A set of samples was compared for cytologic efficacy in 76 patients with surgically proven bile duct cancer and in 50 patients with benign biliary stricture. Results: The cytologic sensitivity for diagnosing biliary cancer was 34 % with aspirated bile, 32 % with brush smear, 43 % with brush-rinsed saline, and 70 % with post-brushing biliary lavage fluid, in contrast to the null false-positive result in the benign cases. The sensitivity of cytology was significantly higher with post-brushing lavage fluid than with the other three sampling methods (P < 0.0001), and post-brushing lavage fluid improved the cumulative sensitivity by 24 % (P = 0.002). The sensitivity of biliary cytology was also associated with the amount of aspirated bile (P = 0.01) and with the aspiration site (P = 0.03). The rate of cancer positivity in a cytology set differed according to the tumor macroscopic type (85 % in the protruding type vs. 40 % in the flat type; P = 0.003), and according to the size of the cancer (87 % for tumors ≥ 50 mm vs. 66 % for tumors < 50 mm; P = 0.02). Conclusions: Post-brushing biliary lavage fluid cytology provides superior diagnostic efficacy, and its addition to ERCP procedures is recommended for obtaining cytologic evidence of bile duct cancer.

[1]  H. Ono,et al.  IgG4‐related sclerosing cholangitis without obvious pancreatic lesion: Difficulty in differential diagnosis , 2014, Journal of digestive diseases.

[2]  Chengquan Zhao,et al.  Room for improvement: initial experience with anal cytology: observations from the College of American Pathologists interlaboratory comparison program in nongynecologic cytology. , 2013, Archives of pathology & laboratory medicine.

[3]  Y. Nakanuma,et al.  Clinical diagnostic criteria of IgG4-related sclerosing cholangitis 2012 , 2012, Journal of hepato-biliary-pancreatic sciences.

[4]  B. Chadwick Beyond cytomorphology: Expanding the diagnostic potential for biliary cytology , 2012, Diagnostic cytopathology.

[5]  B. Gridelli,et al.  Intraductal aspiration: a promising new tissue-sampling technique for the diagnosis of suspected malignant biliary strictures. , 2012, Gastrointestinal endoscopy.

[6]  M. Unno,et al.  The evaluation of MSX2 mRNA expression level in biliary brush cytological specimens. , 2011, Anticancer research.

[7]  T. Fujita,et al.  Incidence, clinical presentation and pathological features of benign sclerosing cholangitis of unknown origin masquerading as biliary carcinoma , 2010, Journal of hepato-biliary-pancreatic sciences.

[8]  M. Nagino,et al.  Clinicopathologic Study of Cholangiocarcinoma With Superficial Spread , 2009, Annals of surgery.

[9]  F. Smedts,et al.  Cytological punctures in the diagnosis of renal tumours: a study on accuracy and reproducibility. , 2009, European urology.

[10]  C. Livasy,et al.  Use of the ThinPrep® method in bile duct brushings: Analysis of morphologic parameters associated with malignancy and determination of interobserver reliability , 2008, Diagnostic cytopathology.

[11]  T. V. van Gulik,et al.  Immunoglobulin G4‐related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures , 2008, The British journal of surgery.

[12]  T. Shimosegawa,et al.  Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal , 2006, Journal of Gastroenterology.

[13]  S. Sherman,et al.  Effectiveness of a new long cytology brush in the evaluation of malignant biliary obstruction: a prospective study. , 2006, Gastrointestinal endoscopy.

[14]  M. D'Angelica,et al.  Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma. , 2005, Journal of the American College of Surgeons.

[15]  T. Therneau,et al.  A Comparison of Routine Cytology and Fluorescence in situ Hybridization for the Detection of Malignant Bile Duct Strictures , 2004, The American Journal of Gastroenterology.

[16]  T. Baron,et al.  Prospective, Blinded Assessment of Factors Influencing the Accuracy of Biliary Cytology Interpretation , 2004, American Journal of Gastroenterology.

[17]  S. Selvaggi Biliary brushing cytology , 2004, Cytopathology : official journal of the British Society for Clinical Cytology.

[18]  L. Ylagan,et al.  Endoscopic bile duct brushing of malignant pancreatic biliary strictures: Retrospective study with comparison of conventional smear and ThinPrep® techniques , 2003, Diagnostic cytopathology.

[19]  Y. Nimura,et al.  Pathological appraisal of lines of resection for bile duct carcinoma , 2002, The British journal of surgery.

[20]  T. Tammela,et al.  Differences between local and review urinary cytology in diagnosis of bladder cancer. An interobserver multicenter analysis. , 2002, European urology.

[21]  R. Chuttani,et al.  The combination of stricture dilation, endoscopic needle aspiration, and biliary brushings significantly improves diagnostic yield from malignant bile duct strictures. , 2001, Gastrointestinal endoscopy.

[22]  S. Krishnamurthy,et al.  DNA image analysis combined with routine cytology improves diagnostic sensitivity of common bile duct brushing , 2001, Cancer.

[23]  M F Dixon,et al.  The Vienna classification of gastrointestinal epithelial neoplasia , 2000, Gut.

[24]  S. Sherman,et al.  Triple-tissue sampling at ERCP in malignant biliary obstruction. , 2000, Gastrointestinal endoscopy.

[25]  M. Stolte,et al.  Differences in diagnostic criteria for gastric carcinoma between Japanese and Western pathologists , 1997, The Lancet.

[26]  J. Mansfield,et al.  A prospective evaluation of cytology from biliary strictures. , 1997, Gut.

[27]  Y. Atomi,et al.  Endoscopic transpapillary bile duct biopsy without sphincterotomy for diagnosing biliary strictures: a prospective comparative study with bile and brush cytology. , 1996, The American journal of gastroenterology.

[28]  T. Ponchon,et al.  Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. , 1995, Gastrointestinal endoscopy.