VALUE OF ENDOBILIARY BRUSH CYTOLOGY AND BIOPSIES FOR THE DIAGNOSIS OFMALIGNANT BILE-DUCT STENOSIS - RESULTS OF A PROSPECTIVE-STUDY

Background: Before considering a nonsurgical method of management of a bile duct stenosis, a tissue diagnosis is highly desirable. In a pros pective study we have evaluated the feasibility and reliability of end obiliary brush cytology and biopsies performed at the time of endoscop ic retrograde cholangiography. Methods: Two hundred thirty-three conse cutive patients underwent an attempt at endobiliary brush cytology and biopsies of bile duct stenosis when no mass was detected on ultrasoun d and CT scan. Results: The material for cytology was sufficient for a nalysis in 210 cases (90%) and biopsies were obtained in 128 cases (55 %). One hundred fifteen patients had both cytology and biopsies (49%). For the diagnosis of malignant stenosis, the sensitivity was 35% for cytology, 43% for biopsies, and 63% for the combination of cytology an d biopsies. For both cytology and biopsies, the specificity was 97%. I n the cases of cancer primarily involving the bile ducts, the sensitiv ity was 86% when combining both cytology and biopsies. Conclusions: En dobiliary sampling is technically difficult and has a limited sensitiv ity for the diagnosis of malignant biliary stenosis. Biopsies should b e combined with cytology to increase the sensitivity.