Diagnostic Efficacy of Brush Cytology in the Evaluation of Extrahepatic Bile Duct Strictures: Experience from a Tertiary Care Centre in Northern India

Seetu Palo; Ram Nawal Rao

doi:10.21276/apalm.3528

Authors

Seetu Palo Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bibinagar, Telangana, India
Ram Nawal Rao Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

DOI:

https://doi.org/10.21276/apalm.3528

Keywords:

Brush cytology, Common bile duct, Endoscopic retrograde cholangiopancreatography, Obstructive jaundice, Percutaneous transhepatic cholangiography

Abstract

Background: Endoscopic evaluation is critical in assessing the cause of obstructive jaundice. Biliary brushings during endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) are widely used for obtaining a tissue sample. This study was undertaken to investigate the role of endoscopic biliary tract brush cytology as a diagnostic tool in extrahepatic biliary strictures.

Materials and Methods: During the 6-year study period, 80 jaundiced patients underwent ERCP (n=63) / PTC (n=17) along with cytological evaluation of biliary brushings. Demographic data and relevant clinico-radiological details were retrospectively retrieved from institutional records. The corresponding cytological smears were re-evaluated and classified as: (i) unsatisfactory/inadequate; (ii) negative (including benign and reactive); (iii) suspicious for malignancy; (iv) positive for malignancy. Cytology results were compared with final diagnosis (defined as either definitive tissue diagnosis or clinico-radiological follow-up), and sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) were calculated.

Results: The age group of patients ranged from 15 to 85 years, with mean age of presentation being 52.7 years. Cytologic diagnosis was: positive for malignancy in 23 (26.7%), suspicious in 8 (9.3%), and benign/reactive/negative in 52 (60.5%) cases. In the 61 cases where the final diagnosis was available, the overall SN, SP, PPV, NPV, and DA of biliary brush cytology were 68.57%, 92.31%, 92.31%, 68.57%, and 78.69%, respectively. There was no significant difference in DA of brushings obtained at ERCP compared to those from PTC.

Conclusion: We found directly-smeared brush cytology to be diagnostically reliable, moderately sensitive, and highly specific for diagnosing common bile duct lesions encountered at ERCP/PTC.

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