THE YIELD OF BILIARY BRUSH CYTOLOGY IN BILIARY STRICTURES

Aims The aim of this study is to assess the yield of biliary brush cytology into determining malignant causes of biliary stricture.

Methods We performed a prospective study from January 2016 to December 2021 including patients with biliary stricture who had biliary brush sampling. Exclusion criteria were patients with biliary stricture for whom brush sampling was not possible. Final diagnosis was confirmed by surgery, percutaneous biopsy or EUS-FNA, radiological invasion or metastasis to identify false positive or false negative results. Analysis was made using SPSS.

Results 1,100 patients underwent ERCP during this 5-year period. Out of these, 82 patients used biliary brushing for diagnosis. The mean age of our patients was 65 years (26–95 years, 56.1% females). The main symptom was obstructive jaundice in 91.7% of patients (n=77). Of the 82 patients, 40 (47.6%) had distal common bile duct stricture, 8 (9.5%) had middle stricture and 19 (22.6%) had a proximal /complex hilar stricture. 75% of strictures were due to malignant causes. Cholangiocarcinoma, pancreatic cancer and gallbladder carcinoma were the most common causes of malignant biliary stricture at 27,4%, 26,2% and 16,7%. The sensitivity, specificity, positive predictive value and negative predictive value were 33.3, 100, 100 and 25.9%, respectively. For cholangiocarcinomas, the sensitivity was the highest at 56,5%. For pancreatic cancer and gallbladder carcinoma, the sensitivity was very low at 14,2% and 15,3%.

Conclusions Despite its low sensitivity, brush cytology is considered to be a safe way to get tissue samples from patients suspected with biliary neoplasm.

Publication History

Article published online:
14 April 2022