Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study

• Published in: Gastrointestinal endoscopy 1995-12, Vol.42 (6), p.565-572
• Main Authors: Ponchon, Thierry, Gagnon, Pierre, Berger, Francoise, Labadie, Michel, Liaras, Anita, Chavaillon, Annick, Bory, Roger
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms - complications; Bile Duct Neoplasms - pathology; Biological and medical sciences; Biopsy; Cholangiography - methods; Constriction, Pathologic - etiology; Cytological Techniques; Diagnosis, Differential; Digestive system; Endoscopy, Digestive System; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Prospective Studies; Sensitivity and Specificity
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(95)70012-9

Background: Before considering a nonsurgical method of management of a bile duct stenosis, a tissue diagnosis is highly desirable. In a prospective study we have evaluated the feasibility and reliability of endobiliary brush cytology and biopsies performed at the time of endoscopic retrograde cholangiography. Methods: Two hundred thirty-three consecutive patients underwent an attempt at endobiliary brush cytology and biopsies of bile duct stenosis when no mass was detected on ultrasound and CT scan. Results: The material for cytology was sufficient for analysis in 210 cases (90%) and biopsies were obtained in 128 cases (55%). One hundred fifteen patients had both cytology and biopsies (49%). For the diagnosis of malignant stenosis, the sensitivity was 35% for cytology, 43% for biopsies, and 63% for the combination of cytology and biopsies. For both cytology and biopsies, the specificity was 97%. In the cases of cancer primarily involving the bile ducts, the sensitivity was 86% when combining both cytology and biopsies. Conclusions: Endobiliary sampling is technically difficult and has a limited sensitivity for the diagnosis of malignant biliary stenosis. Biopsies should be combined with cytology to increase the sensitivity. (Gastrointest Endosc 1995;42:565-72.)