A PROSPECTIVE EVALUATION OF CYTOLOGY FROM BILIARY STRICTURES

Background-Bile duct strictures may be benign or malignant. A definite diagnosis is desirable to advise patients of their prognosis and to i dentify any amenable to curative surgery. Aims-To compare different me thods of cytology sampling from biliary strictures and evaluate the us e of cytology in this context. Patients and methods-In a prospective s tudy 54 patients undergoing endoscopic retrograde cholangiopancreatogr aphy (ERCP) had cytology samples obtained as follows: (1) biliary stri cture brushings, (2) from the screw thread of a ''Soehendra stent retr iever'' inserted through the stricture, (3) from the proximal end of a blocked biliary stent, and (4) cellular material spun down from a 20 mi specimen of bile. Examination of slides and rinsings was performed by an expert cytologist who graded them for the adequacy of the sample and for evidence of malignancy. Results-Prolonged follow up disclosed malignancy in 52 of the 54 cases, the other two being chronic pancrea titis. Bile samples provided adequate cytology samples in 44%, the Soe hendra stent retriever in 70%, retrieved stents in 84%, and cytology b rush sampling in 96%. Overall, 28 malignancies were detected by cytolo gy, including 14 of 28 pancreatic carcinomas and 12 of 16 cholangiocar cinomas. Twenty two of the malignancies were detected by brush samplin g and the other methods added a total of another six cases. Conclusion s-Cytology sampling is best done by brushing the biliary stricture. Cy tology sampling can confirm the diagnosis in 75% of cholangiocarcinoma s and 50% of pancreatic carcinomas. The techniques involved are simple to perform and should be routine clinical practice whenever potential ly malignant biliary strictures are encountered at ERCP.