title: Role of biliary tract cytology in the evaluation of extrahepatic cholestatic jaundice.
abstract: BACKGROUND
  Endoscopic evaluation is critical in assessing the cause of obstructive jaundice. Cytological techniques including bile aspiration and biliary brushings have become the initial diagnostic modality.
  
  
  OBJECTIVE
  The aim of this study is to evaluate the role of endoscopic biliary tract cytology as a diagnostic tool in the evaluation of extrahepatic cholestatic jaundice.
  
  
  METHODS
  A total of 56 biliary tract specimens including 34 bile aspirations and 22 biliary brushings from 41 consecutive patients who had presented with obstructive jaundice and underwent endoscopic retrograde cholangiopancreatography (ERCP) were assessed by cytological examination. The smears prepared were analyzed for standard cytological features.
  
  
  RESULTS
  Cytologic diagnosis was adenocarcinoma in 13 (31.7%) cases, atypical in 2 (4.9%), reactive in 3 (7.3%) and benign changes in 19 (46.3%) cases. 4 (9.8%) cases were non-diagnostic. Serum bilirubin was significantly elevated in the malignant group. Biliary stricture was the most common finding on ERCP (68.3%). On cytological examination, presence of solitary, intact atypical cells, enlarged nuclei, irregular nuclear membrane, coarse chromatin and nucleoli were important cytologic criteria for differentiating malignant from benign biliary specimens.
  
  
  CONCLUSIONS
  Regular use of bile cytology and brushings during ERCP evaluation of extrahepatic cholestatic jaundice is invaluable in obtaining a morphologic diagnosis. A systematic approach, use of strict cytomorphologic criteria and inclusion of significant atypia as malignant diagnosis may improve the sensitivity.
authors.affiliation: Department of Pathology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.
authors.forename: Mamta
authors.initials: M
authors.lastname: Gupta
authors.forename: Radha R
authors.initials: RR
authors.lastname: Pai
authors.forename: Devi
authors.initials: D
authors.lastname: Dileep
authors.forename: Sandeep
authors.initials: S
authors.lastname: Gopal
authors.forename: Suresh
authors.initials: S
authors.lastname: Shenoy
keywords: Bile; biliary tract; endoscopic retrograde cholangiopancreatography; extrahepatic cholestasis