Limits...
Diagnosis of bile duct cancer by bile cytology: usefulness of post-brushing biliary lavage fluid.

Sugimoto S, Matsubayashi H, Kimura H, Sasaki K, Nagata K, Ohno S, Uesaka K, Mori K, Imai K, Hotta K, Takizawa K, Kakushima N, Tanaka M, Kawata N, Ono H - Endosc Int Open (2015)

Bottom Line: The cytologic sensitivity for diagnosing biliary cancer was 34 % with aspirated bile, 32 % with brush smear, 43 % with brush-rinsed saline, and 70 % with post-brushing biliary lavage fluid, in contrast to the false-positive result in the benign cases.The sensitivity of cytology was significantly higher with post-brushing lavage fluid than with the other three sampling methods (P < 0.0001), and post-brushing lavage fluid improved the cumulative sensitivity by 24 % (P = 0.002).The sensitivity of biliary cytology was also associated with the amount of aspirated bile (P = 0.01) and with the aspiration site (P = 0.03).

View Article: PubMed Central - PubMed

Affiliation: Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.

ABSTRACT

Background: Pathologic evidence of biliary diseases can be obtained from cytology in addition to endoscopic retrograde cholangiopancreatography (ERCP); however, the diagnostic effectiveness is not satisfactory.

Study aim: This retrospective, single-center study evaluated the efficacy of various sampling methods for the cytologic diagnosis of bile duct cancer.

Patients and methods: Biliary samples included bile that was simply aspirated, brush smear, brush-rinsed saline, and post-brushing biliary lavage fluid. A set of samples was compared for cytologic efficacy in 76 patients with surgically proven bile duct cancer and in 50 patients with benign biliary stricture.

Results: The cytologic sensitivity for diagnosing biliary cancer was 34 % with aspirated bile, 32 % with brush smear, 43 % with brush-rinsed saline, and 70 % with post-brushing biliary lavage fluid, in contrast to the false-positive result in the benign cases. The sensitivity of cytology was significantly higher with post-brushing lavage fluid than with the other three sampling methods (P < 0.0001), and post-brushing lavage fluid improved the cumulative sensitivity by 24 % (P = 0.002). The sensitivity of biliary cytology was also associated with the amount of aspirated bile (P = 0.01) and with the aspiration site (P = 0.03). The rate of cancer positivity in a cytology set differed according to the tumor macroscopic type (85 % in the protruding type vs. 40 % in the flat type; P = 0.003), and according to the size of the cancer (87 % for tumors ≥ 50 mm vs. 66 % for tumors < 50 mm; P = 0.02).

Conclusions: Post-brushing biliary lavage fluid cytology provides superior diagnostic efficacy, and its addition to ERCP procedures is recommended for obtaining cytologic evidence of bile duct cancer.

No MeSH data available.


Related in: MedlinePlus

 Cytologic views of post-brushing biliary lavage fluid (Papanicolaou stain, original magnification × 400). a Normal biliary epithelial cells (class I) appearing as a sheet of benign epithelium. The sheet consists of regularly ordered, homogeneous cuboidal cells. b Benign biliary epithelial cells with cellular atypia (class III) appearing as a cluster of inflammatory cells and epithelial cells with enlarged nuclei and architectural disorganization. c A cluster of adenocarcinoma cells (class V) appearing as nested epithelial cells with significantly enlarged nuclei and irregular nuclear margins.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4554506&req=5

FI130-2:  Cytologic views of post-brushing biliary lavage fluid (Papanicolaou stain, original magnification × 400). a Normal biliary epithelial cells (class I) appearing as a sheet of benign epithelium. The sheet consists of regularly ordered, homogeneous cuboidal cells. b Benign biliary epithelial cells with cellular atypia (class III) appearing as a cluster of inflammatory cells and epithelial cells with enlarged nuclei and architectural disorganization. c A cluster of adenocarcinoma cells (class V) appearing as nested epithelial cells with significantly enlarged nuclei and irregular nuclear margins.

Mentions: All specimens were stained with Papanicolaou solution and rated as class I to V. Cytologic findings considered suggestive of malignancy were the following: irregularly arranged nuclei, irregular margins for clusters, enlarged nuclei, irregularly shaped nuclei, and abnormal chromatin 1516. Other notable findings were a necrotic background and cell clusters of different sizes. The biliary cytology was graded according to the combinations of these cytologic findings. The diagnostic grading system used in the present study was as follows: inadequate; benign (class I) (Fig. 2 a); atypical cells present (class II); suspicious for cells from a neoplastic lesion (class III) (Fig. 2 b); strongly suspicious for malignancy (class IV); and definitely malignant (class V) (Fig. 2 c). In this study, classes I through III were regarded as benign, and classes IV and V as malignant (positive for cancer). Cytologic evaluation was performed before the surgical resection in all cases by a single specialist (K. S., listed as a co-author) in the field of hepatico-biliary-pancreatic pathology.


Diagnosis of bile duct cancer by bile cytology: usefulness of post-brushing biliary lavage fluid.

Sugimoto S, Matsubayashi H, Kimura H, Sasaki K, Nagata K, Ohno S, Uesaka K, Mori K, Imai K, Hotta K, Takizawa K, Kakushima N, Tanaka M, Kawata N, Ono H - Endosc Int Open (2015)

 Cytologic views of post-brushing biliary lavage fluid (Papanicolaou stain, original magnification × 400). a Normal biliary epithelial cells (class I) appearing as a sheet of benign epithelium. The sheet consists of regularly ordered, homogeneous cuboidal cells. b Benign biliary epithelial cells with cellular atypia (class III) appearing as a cluster of inflammatory cells and epithelial cells with enlarged nuclei and architectural disorganization. c A cluster of adenocarcinoma cells (class V) appearing as nested epithelial cells with significantly enlarged nuclei and irregular nuclear margins.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554506&req=5

FI130-2:  Cytologic views of post-brushing biliary lavage fluid (Papanicolaou stain, original magnification × 400). a Normal biliary epithelial cells (class I) appearing as a sheet of benign epithelium. The sheet consists of regularly ordered, homogeneous cuboidal cells. b Benign biliary epithelial cells with cellular atypia (class III) appearing as a cluster of inflammatory cells and epithelial cells with enlarged nuclei and architectural disorganization. c A cluster of adenocarcinoma cells (class V) appearing as nested epithelial cells with significantly enlarged nuclei and irregular nuclear margins.
Mentions: All specimens were stained with Papanicolaou solution and rated as class I to V. Cytologic findings considered suggestive of malignancy were the following: irregularly arranged nuclei, irregular margins for clusters, enlarged nuclei, irregularly shaped nuclei, and abnormal chromatin 1516. Other notable findings were a necrotic background and cell clusters of different sizes. The biliary cytology was graded according to the combinations of these cytologic findings. The diagnostic grading system used in the present study was as follows: inadequate; benign (class I) (Fig. 2 a); atypical cells present (class II); suspicious for cells from a neoplastic lesion (class III) (Fig. 2 b); strongly suspicious for malignancy (class IV); and definitely malignant (class V) (Fig. 2 c). In this study, classes I through III were regarded as benign, and classes IV and V as malignant (positive for cancer). Cytologic evaluation was performed before the surgical resection in all cases by a single specialist (K. S., listed as a co-author) in the field of hepatico-biliary-pancreatic pathology.

Bottom Line: The cytologic sensitivity for diagnosing biliary cancer was 34 % with aspirated bile, 32 % with brush smear, 43 % with brush-rinsed saline, and 70 % with post-brushing biliary lavage fluid, in contrast to the false-positive result in the benign cases.The sensitivity of cytology was significantly higher with post-brushing lavage fluid than with the other three sampling methods (P < 0.0001), and post-brushing lavage fluid improved the cumulative sensitivity by 24 % (P = 0.002).The sensitivity of biliary cytology was also associated with the amount of aspirated bile (P = 0.01) and with the aspiration site (P = 0.03).

View Article: PubMed Central - PubMed

Affiliation: Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.

ABSTRACT

Background: Pathologic evidence of biliary diseases can be obtained from cytology in addition to endoscopic retrograde cholangiopancreatography (ERCP); however, the diagnostic effectiveness is not satisfactory.

Study aim: This retrospective, single-center study evaluated the efficacy of various sampling methods for the cytologic diagnosis of bile duct cancer.

Patients and methods: Biliary samples included bile that was simply aspirated, brush smear, brush-rinsed saline, and post-brushing biliary lavage fluid. A set of samples was compared for cytologic efficacy in 76 patients with surgically proven bile duct cancer and in 50 patients with benign biliary stricture.

Results: The cytologic sensitivity for diagnosing biliary cancer was 34 % with aspirated bile, 32 % with brush smear, 43 % with brush-rinsed saline, and 70 % with post-brushing biliary lavage fluid, in contrast to the false-positive result in the benign cases. The sensitivity of cytology was significantly higher with post-brushing lavage fluid than with the other three sampling methods (P < 0.0001), and post-brushing lavage fluid improved the cumulative sensitivity by 24 % (P = 0.002). The sensitivity of biliary cytology was also associated with the amount of aspirated bile (P = 0.01) and with the aspiration site (P = 0.03). The rate of cancer positivity in a cytology set differed according to the tumor macroscopic type (85 % in the protruding type vs. 40 % in the flat type; P = 0.003), and according to the size of the cancer (87 % for tumors ≥ 50 mm vs. 66 % for tumors < 50 mm; P = 0.02).

Conclusions: Post-brushing biliary lavage fluid cytology provides superior diagnostic efficacy, and its addition to ERCP procedures is recommended for obtaining cytologic evidence of bile duct cancer.

No MeSH data available.


Related in: MedlinePlus