title: Cytodiagnosis in the management of extrahepatic biliary stricture.
abstract: A total of 117 patients presenting with extrahepatic biliary strictures between 1981 and 1989 had 206 cytological examinations of the bile duct or bile (153 non-operative, 53 intraoperative) to establish the presence of malignancy. A final diagnosis of cholangiocarcinoma was made in 88 patients, with 29 patients having benign biliary strictures. The cytological techniques used were fine needle aspiration (n = 102) or brushing (n = 24) of the bile duct, or exfoliative cytology of bile (n = 80). Forty one patients with malignancy had two or more examinations with differing results between samples in 20 cases. The overall sensitivity was 72%. There was only one false positive result, giving a patient predictive value of positive cytology of 98%. Intraoperative cytology was more sensitive than non-operative examination (80% v 42%). Overall, the sensitivity of fine needle aspiration (67%) was greater than that of brush cytology (40%) or exfoliative cytology (30%). No complications were encountered. Cytodiagnosis of extrahepatic biliary strictures is a safe procedure which is not technically demanding, and as it has a high sensitivity and predictive value for positive cytology, cytological confirmation of malignancy should be sought in all clinically and radiologically suspicious cases.
authors.affiliation: Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London.
authors.forename: L A
authors.initials: LA
authors.lastname: Desa
authors.forename: A B
authors.initials: AB
authors.lastname: Akosa
authors.forename: S
authors.initials: S
authors.lastname: Lazzara
authors.forename: P
authors.initials: P
authors.lastname: Domizio
authors.forename: T
authors.initials: T
authors.lastname: Krausz
authors.forename: I S
authors.initials: IS
authors.lastname: Benjamin
mesh_terms: D002759:Adenoma, Bile Duct / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D001707:Biopsy, Needle; D001651:Cholestasis, Extrahepatic / Q000209:etiology*; D003581:Cytodiagnosis / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity