Comparison between endoscopic brush cytology performed before and after biliary stricture dilation for cancer detection.
BACKGROUND
Confirmation of malignancy within biliary strictures is endoscopically challenging. Dilation of strictures has been reported to enhance cytological diagnosis.


OBJECTIVE
To compare brush cytology results before and after biliary stricture dilation.


METHODS
Patients with extra-hepatic biliary stricture at endoscopic retrograde cholangiopancreatography were included in the study. Brushing was performed before and immediately after dilation using a 10 Fr dilating catheter. Cytology samples were classified as: negative for malignancy, presence of atypical cells, insufficient material, suspicious for malignancy or positive for malignancy. Final diagnosis was established by surgery, biopsy or follow-up.


RESULTS
Biliary brush cytology was performed in 50 patients, with an overall sensitivity of 40% and 27.5%, before and after dilation, respectively. The combination of results increased cancer detection rate to 45%. There were 5/50 (10%) minor complications and one death related to the procedure.


CONCLUSIONS
Brush cytology performed before biliary stricture dilation has a similar cancer detection rate to that following dilation, although the combination of results enhances sensitivity.
Ornellas
Laura Cotta
LC
Department of Gastroenterology, Federal University of São Paulo, SP, Brazil. lauraornellas@hotmail.com
Santos
Gilda da Cunha
Gda C
Nakao
Frank Shigueo
FS
Ferrari
Angelo Paulo
AP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000473:pathology*; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000473:pathology* / Q000628:therapy; D003584:Cytological Techniques / Q000379:methods; D006801:Humans; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity