A New Method of Biliary Sampling for Cytopathological Examination

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A New

Method of Biliary Sampling for Cytopathological

Examination During Endoscopic Retrograde Cholangiography

Authors:

Dumonceau, Jean-Marc; Casco,

; Landoni, Nestor; Frossard, Jean-Louis; Hadengue,

Antoine; Pache, Jean-Claude; Genevay, Muriel; Morel, Philippe; Kumar, Neeta; Bongiovanni, Massimo

Source: The American

Journal of Gastroenterology, Volume 102, Number 3

March 2007,

pp. 550-557(8)

Publisher: Blackwell Publishing

Abstract:

Biliary

brushing during endoscopic retrograde cholangiography (ERC)

may allow the diagnosis of cancer, but this technique is limited by a low

(18-57%) sensitivity. We compared the cellular and

diagnostic yields of a new sampling method (using stricture dilation and a

grasping basket) with those of brushing.

ETHODS:

Sixty consecutive patients with a suspected malignant obstruction of the common

bile duct were included in a consecutive, nonrandomized order.

They underwent sampling during ERC using the new method (study patients,

N = 30) or a brush (control patients, N = 30). A final

diagnosis of cancer was made in 22/30 (73%) study patients and 21/30 (70%)

control patients. At the end of the study period, all

smears were interpreted at cytopathological

examination in a blind and random fashion for cellularity

(insufficient, low, moderate, or high) and diagnosis (normal, atypical

considered reactive, highly atypical suspicious for cancer, or malignant). “Highly atypical†and “malignant†diagnoses were

considered as indicative of cancer.

Compared

with biliary brushing, the new method provided a high cellular yield in more

cases (19/30 vs 10/30, P=

0.020), a higher sensitivity for the detection of cancer (19/22 [86%]vs 11/21

[52%], P= 0.015), and a higher

diagnostic accuracy (27/30 [90%]vs 20/30 [67%], P=

0.028). Specificity for the detection of cancer was

100%. The 30-d complication rate observed with the new

method was 3%.

CONCLUSIONS:

Significantly higher cellular and diagnostic yields can be obtained at ERC in

patients with suspected malignant biliary stricture by combining stricture

dilation and a grasping basket compared with brushing.

(Am J Gastroenterol 2007;102:550-557)

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