Diagnostic Yield of Brush Cytology for Biliary Strictures during ERCP

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Purpose: Biliary tract stenoses are a common finding in ERCPs performed on patients with obstructive jaundice. Pathological diagnosis is essential to guide treatment and prevent more invasive diagnostic workup. Current sampling techniques for obtaining bile duct samples during ERCP include intraductal bile aspiration cytology, endobiliary forceps biopsy, brush cytology, fine-needle aspiration (FNA), cytology, and cytopathologic analysis of retrieved plastic biliary stents. Brush cytology is the most frequently used tissue sampling technique due to its simplicity, safety, and wide availability. A modest overall mean sensitivity of 42% represents its main limitation, although sensitivity varies in published studies. Objectives: The aim of this study was to assess the yield of brush cytology in patients with biliary strictures detected at ERCP when a systematic approach is used and when a dedicated pathologist performs the cytological analysis. Methods: A descriptive, crossed, observational study was designed to study the validity of diagnostic brush cytology during ERCP in biliary stenosis. Patients found to have a biliary stricture at ERCP who underwent biliary brushing cytology were included. We reviewed all ERCPs performed from January, 2012 to December, 2012. During a standard ERCP, a brushing was obtained and the cytology specimen was immediately transferred to a glass slide by the nursing staff by smearing the cellular material directly from the brush. The slides were then immersed in fixative (alcohol). Subsequently, a dedicated pathologist conducted the cytological analysis and classified the samples into three categories: positive for malignancy, negative for malignancy, or invalid. Results: A total of 26 patients underwent brushing for cytology in strictures seen at ERCP. There were 17 females and 9 males; 44% of the patients were between 45 and 65 years of age and 56% were older than 65 years. Overall sensitivity was 62% (78% in males and 53% in females). This is better than the previously reported sensitivity of around 40% in the literature. Conclusion: Brushing the biliary strictures for cytology remains a sensitive method of diagnosis of biliary malignancies. Using a rapid fixing technique and single dedicated pathologist reviewing the slides appears to be the reason for this high yield.