Abstract
Bile Duct Brush Cytology - Challenges, Limitations and Ancillary Studies
Highlights
The use of Endoscopic Retrograde CholangioPancreatography (ERCP) was first reported in 1968 and since it has served as an effective technique in evaluation and treatment of pancreatic and biliary diseases
Osnes et al introduced use of brush with ERCP in mid 1970s, and brush cytology of the bile duct, pancreatic duct, common bile duct and the ampulla has become an established tool in evaluating obstructive biliary strictures and masses since
Clinical management of biliary strictures is a difficult diagnostic problem and cytology remains the initial choice in determining the precise nature of these lesions preoperatively, given that significant complications may arise from biopsy at these sites [1,2]
Summary
Brush cytology of the bile duct, pancreatic duct, common bile duct and the ampulla has become an established tool in evaluating obstructive biliary strictures and masses since mid 1970s. Most benign strictures are managed by ductal dilatation or stenting while for the malignant strictures Whipple resection or bile duct resection is undertaken when operable. Confirmation of the benign or malignant nature of the stricture is of prime clinical importance. Recognition of certain key features on cytology can help categorise these cases into suitable definitive categories and help the clinicians to better and timely manage patients. The cytology of the biliary tract has a high specificity, but its sensitivity is quite poor. Growing wealth of ancillary tests can be utilised with the indeterminate cytology results to facilitate patient outcome
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