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.
