Brushing off uncertainty: A review of Biliary brushings taken during ERCP in Barts Health NHS, UK

Aims The current UK guidelines recommend cytological analysis of brushings taken from biliary strictures to support diagnosis of malignancy in suspected patients. There is wide variation reported in literature on test sensitivities ranging between 16% – 65%. We set out to report a single NHS trust experience on the diagnostic yield of brush cytology specimens of biliary strictures obtained during ERCP [1].

Methods The methodology involved retrospective analysis in collaboration with the pathology team, obtaining list of all biliary brushing specimens from 2021–2022 at Barts Health NHS in London, UK. Comprehensive information gathering from patient records included pathology reports, radiological reports, Hepatopancreatobiliary Multidisciplinary Team meeting outcomes, clinic letters, and other relevant investigations.

Results Results revealed a total of 144 cases, comprising 109 cancer cases and 35 benign cases. Among the cancer cases, further breakdown of results is shown:

Total number of patients with cancer – 109

Brushings positive for cancer – 19

Brushings suspicious for cancer – 31

Combined positive and suspicious for cancer – 48

Brushings negative for cancer – 61

The sensitivity and specificity of the biliary brushings were calculated at 44% and 100%, respectively

Conclusions There was significant numbers of cancer patients with suspicious or negative brushings requiring alternative methods to reach diagnosis (EUS FNB, percutaneous biopsies etc). As ERCP is often required to decompress the bile duct, we believe that brushing should be taken as part of the procedure. However, with alternative methods providing better diagnostic yield, brushings cannot necessarily be relied upon. The findings were presented to the trusts ERCP operators meeting and further plans were made to re-audit biliary brushings in the future having adjusted the sampling protocol.

Publication History

Article published online:
27 March 2025

• References

• 1 National Institute for Health and Care Excellence (NICE) (2016) Suspected cancer: recognition and referral. NICE guideline [NG12]