BILIARY STENT REPLACEMENT CYTOLOGY

Using fluoroscopic guidance, polyethylene biliary stents are replaced endoscopically or per-cutaneously when bile duct stenosis recurs. To i mprove the sensitivity of conventional biliary cytology, we examined c ells recovered from removed stents. Biliary stents removed endoscopica lly from each of II patients were rinsed with saline; next, the rinse was centrifuged and the sediment smeared and Papanicolaou stained. Thr ee patients with choledocholithiasis had biliary stent replacement cyt ology (BSRC) to exclude a neoplastic etiology. Eight patients with cli nicoradiologic evidence of hepatobiliary, or pancreatic carcinoma had BSRCs performed for pathologic documentation of carcinoma. BSRC from s ix of eight patients with clinicoradiologically malignant biliary stri ctures contained malignant cells, predominantly in loose clusters, but also singly (sensitivity 75%, specificity 100%; positive predictive v alue 75%, negative predictive value 60%). Reparative epithelial atypia was also present in all cases. BSRC from two patients with clinicorad iological evidence of carcinoma of the biliary region and from three w ith choledocholithiasis contained only bile pigment, leukocytes, and b enign epithelial cells. The sampling of cells which have accumulated o n, or ill biliary stents, improves the sensitivity of biliary cytology . This is most applicable when 1) a patient is inoperable, 2) tissue b iopsy is neither feasible nor diagnostic, 3) prior brush, suction, per cutaneous, or endoscopic needle aspiration cytology is inconclusive, a nd 4) permanent metal stent is needed. (C) 1997 Wiley-Liss, Inc.