Skip to main content
SpringerLink
Log in

Bile Duct Brush Cytology

  • Chapter
  • First Online:
Pancreas and Biliary Tract Cytohistology

Part of the book series: Essentials in Cytopathology ((EICP,volume 28))

  • 883 Accesses

Abstract

The determination of biliary strictures as benign or malignant is challenging in clinical practice. It requires a multidisciplinary approach comprising of clinical, imaging, and pathologic findings. Most of the biliary strictures are malignant, the most common malignancies being pancreatic ductal adenocarcinomas, cholangiocarcinomas, and peri-ampullary carcinomas. The diagnosis of malignancy aids in early treatment if the tumor is resectable. If unresectable, it helps in planning palliative care. Endoscopic retrograde cholangiopancreatography (ERCP)-guided brush cytology is considered the preferred method for tissue diagnosis of biliary strictures. Histologic sampling in this area can be problematic due to high rate of complications and associated artifacts from tissue crushing and distortion. The sensitivity of brush cytology for diagnosing malignancy ranges from 30% to 89% as per various studies. However, its specificity for malignancy approaches 100%. This chapter discusses the nuances of cytologic features of bile duct brushings (BDB), the diagnostic challenges, and the ancillary studies that can assist in their evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Singh A, Gelrud A, Agarwal B. Biliary strictures: diagnostic considerations and approach. Gastroenterol Rep (Oxf). 2015;3:22–31. https://doi.org/10.1093/gastro/gou072.

    Article  CAS  Google Scholar 

  2. Costamagna G, Boškoski I. Current treatment of benign biliary strictures. Ann Gastroenterol. 2013;26:37–40.

    PubMed  PubMed Central  Google Scholar 

  3. Cassani L, Lee JH. Management of malignant distal biliary obstruction. Gastrointest Interv. 2015;4:15–20. https://doi.org/10.1016/j.gii.2015.02.001.

    Article  Google Scholar 

  4. National Cancer Institute: Surveillance, Epidemiology and End Results Program. https://seer.cancer.gov/statfacts/html/pancreas.html (2018). Accessed 24 April 2018.

  5. Rösch T, Hofrichter K, Frimberger E, Meining A, Born P, Weigert N, et al. ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc. 2004;60:390–6.

    Article  PubMed  Google Scholar 

  6. Moff SL, Clark DP, Maitra A, Pandey A, Thuluvath PJ. Utility of bile duct brushings for the early detection of cholangiocarcinoma in patients with primary sclerosing cholangitis. J Clin Gastroenterol. 2006;40:336–41.

    Article  PubMed  Google Scholar 

  7. Barr Fritcher EG, Caudill JL, Blue JE, Djuric K, Feipel L, Maritim BK, et al. Identification of malignant cytologic criteria in pancreatobiliary brushings with corresponding positive fluorescence in situ hybridization results. Am J Clin Pathol. 2011;136:442–9. https://doi.org/10.1309/AJCPDULIOEOTUZ5H.

    Article  PubMed  Google Scholar 

  8. Volmar KE, Vollmer RT, Routbort MJ, Creager AJ. Pancreatic and bile duct brushing cytology in 1000 cases: review of findings and comparison of preparation methods. Cancer. 2006;108:231.

    Article  PubMed  Google Scholar 

  9. Stewart CJ, Mills PR, Carter R, O’Donohue J, Fullarton G, Imrie CW, et al. Brush cytology in the assessment of pancreatico-biliary strictures: a review of 406 cases. J Clin Pathol. 2001;54:449–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Kocjan G, Smith AN. Bile duct brushings cytology: potential pitfalls in diagnosis. Diagn Cytopathol. 1997;16:358–63.

    Article  CAS  PubMed  Google Scholar 

  11. Burnett AS, Calvert TJ, Chokshi RJ. Sensitivity of endoscopic retrograde cholangiopancreatography standard cytology: 10-y review of the literature. J Surg Res. 2013;184:304–11. https://doi.org/10.1016/j.jss.2013.06.028.

    Article  PubMed  Google Scholar 

  12. Navaneethan U, Njei B, Lourdusamy V, Konjeti R, Vargo JJ, Parsi MA. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc. 2015;81:168–76. https://doi.org/10.1016/j.gie.2014.09.017.

    Article  PubMed  Google Scholar 

  13. Pugliese V, Conio M, Nicolò G, Saccomanno S, Gatteschi B. Endoscopic retrograde forceps biopsy and brush cytology of biliary strictures: a prospective study. Gastrointest Endosc. 1995;42:520526.

    Article  Google Scholar 

  14. Kawashima H, Itoh A, Ohno E, Goto H, Hirooka Y. Transpapillary biliary forceps biopsy to distinguish benign biliary stricture from malignancy: how many tissue samples should be obtained? Dig Endosc. 2012;24(Suppl 1):22–7. https://doi.org/10.1111/j.1443–1661.2012.01253.x.

    Article  PubMed  Google Scholar 

  15. Ponchon T, Gagnon P, Berger F, Labadie M, Liaras A, Chavaillon A, et al. Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. Gastrointest Endosc. 1995;42:565–72.

    Article  CAS  PubMed  Google Scholar 

  16. Kubota Y, Takaoka M, Tani K, Ogura M, Kin H, Fujimura K, et al. Endoscopic transpapillary biopsy for diagnosis of patients with pancreaticobiliary ductal strictures. Am J Gastroenterol. 1993;88:1700–4.

    CAS  PubMed  Google Scholar 

  17. DeWitt J, Misra VL, Leblanc JK, McHenry L, Sherman S. EUS-guided FNA of proximal biliary strictures after negative ERCP brush cytology results. Gastrointest Endosc. 2006;64:325–33.

    Article  PubMed  Google Scholar 

  18. Ohshima Y, Yasuda I, Kawakami H, Kuwatani M, Mukai T, Iwashita T, et al. EUS-FNA for suspected malignant biliary strictures after negative endoscopic transpapillary brush cytology and forceps biopsy. J Gastroenterol. 2011;46:921–8. https://doi.org/10.1007/s00535–011–0404-z.

    Article  PubMed  Google Scholar 

  19. Brugge W, Dewitt J, Klapman JB, Ashfaq R, Shidham V, Chhieng D, et al. Techniques for cytologic sampling of pancreatic and bile duct lesions. Diagn Cytopathol. 2014;42:333–7. https://doi.org/10.1002/dc.23096.

    Article  PubMed  Google Scholar 

  20. Siddiqui MT, Gokaslan ST, Saboorian MH, Carrick K, Ashfaq R. Comparison of ThinPrep and conventional smears in detecting carcinoma in bile duct brushings. Cancer. 2003;99:205–10.

    Article  PubMed  Google Scholar 

  21. Heath JE, Goicochea LB, Staats PN. Biliary stent related alterations can be distinguished from adenocarcinoma on bile duct brushings using a limited number of cytologic features. J Am Soc Cytopathol. 2015;4:282–9.

    Article  PubMed  Google Scholar 

  22. Goyal A, Sharaiha RZ, Alperstein SA, Siddiqui MT. Cytologic diagnosis of adenocarcinoma on bile duct brushings in the presence of stent associated changes: A retrospective analysis. Diagn Cytopathol. 2018;46:826–32. https://doi.org/10.1002/dc.24052.

    Article  PubMed  Google Scholar 

  23. Layfield LJ, Wax TD, Lee JG, Cotton PB. Accuracy and morphologic aspects of pancreatic and biliary duct brushings. Acta Cytol. 1995;39:11–8.

    CAS  PubMed  Google Scholar 

  24. Pitman MB, Centeno BA, Ali SZ, Genevay M, Stelow E, Mino-Kenudson M, et al. Standardized terminology and nomenclature for pancreatobiliary cytology: the Papanicolaou Society of Cytopathology guidelines. Diagn Cytopathol. 2014;42(4):338–50. https://doi.org/10.1002/dc.23092.

    Article  PubMed  Google Scholar 

  25. Cohen MB, Wittchow RJ, Johlin FC, Bottles K, Raab SS. Brush cytology of the extrahepatic biliary tract: comparison of cytologic features of adenocarcinoma and benign biliary strictures. Mod Pathol. 1995;8:498–502.

    CAS  PubMed  Google Scholar 

  26. Renshaw AA, Madge R, Jiroutek M, Granter SR. Bile duct brushing cytology: statistical analysis of proposed diagnostic criteria. Am J Clin Pathol. 1998;110:635–40.

    Article  CAS  PubMed  Google Scholar 

  27. Salomao M, Gonda TA, Margolskee E, Eguia V, Remotti H, Poneros JM, et al. Strategies for improving diagnostic accuracy of biliary strictures. Cancer Cytopathol. 2015;123:244–52. https://doi.org/10.1002/cncy.21509.

    Article  PubMed  Google Scholar 

  28. Avadhani V, Hacihasanoglu E, Memis B, Pehlivanoglu B, Hanley KZ, Krishnamurti U, et al. Cytologic predictors of malignancy in bile duct brushings: a multi-reviewer analysis of 60 cases. Mod Pathol. 2017;30:1273–86. https://doi.org/10.1038/modpathol.2017.51.

    Article  CAS  PubMed  Google Scholar 

  29. Lee SS, Kim MH, Lee SK, Jang SJ, Song MH, Kim KP, et al. Clinicopathologic review of 58 patients with biliary papillomatosis. Cancer. 2004;100:783–93.

    Article  PubMed  Google Scholar 

  30. Ohtsuka M, Kimura F, Shimizu H, Yoshidome H, Kato A, Yoshitomi H, et al. Similarities and differences between intraductal papillary tumors of the bile duct with and without macroscopically visible mucin secretion. Am J Surg Pathol. 2011;35:512–21. https://doi.org/10.1097/PAS.0b013e3182103f36.

    Article  PubMed  Google Scholar 

  31. Wan XS, Xu YY, Qian JY, Yang XB, Wang AQ, He L, et al. Intraductal papillary neoplasm of the bile duct. World J Gastroenterol. 2013;19:8595–604. https://doi.org/10.3748/wjg.v19.i46.8595.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Logrono R, Kurtycz DF, Molina CP, Trivedi VA, Wong JY, Block KP. Analysis of false-negative diagnoses on endoscopic brush cytology of biliary and pancreatic duct strictures: the experience at 2 university hospitals. Arch Pathol Lab Med. 2000;124:387–92.

    CAS  PubMed  Google Scholar 

  33. Layfield LJ, Cramer H. Primary sclerosing cholangitis as a cause of false positive bile duct brushing cytology: report of two cases. Diagn Cytopathol. 2005;32:119–24.

    Article  PubMed  Google Scholar 

  34. Fritcher EG, Kipp BR, Halling KC, Oberg TN, Bryant SC, Tarrell RF, et al. A multivariable model using advanced cytologic methods for the evaluation of indeterminate pancreatobiliary strictures. Gastroenterology. 2009;136:2180–6. https://doi.org/10.1053/j.gastro.2009.02.040.

    Article  PubMed  Google Scholar 

  35. Barr Fritcher EG, Voss JS, Brankley SM, Campion MB, Jenkins SM, Keeney ME, et al. An optimized set of fluorescence in situ hybridization probes for detection of pancreatobiliary tract Cancer in cytology brush samples. Gastroenterology. 2015;149:1813–1824.e1. https://doi.org/10.1053/j.gastro.2015.08.046.

    Article  CAS  PubMed  Google Scholar 

  36. Kanzawa M, Sanuki T, Onodera M, Fujikura K, Itoh T, Zen Y. Double immunostaining for maspin and p53 on cell blocks increases the diagnostic value of biliary brushing cytology. Pathol Int. 2017;67:91–8. https://doi.org/10.1111/pin.12505.

    Article  CAS  PubMed  Google Scholar 

  37. Tokumitsu T, Sato Y, Yamashita A, Moriguchi-Goto S, Kondo K, Nanashima A, et al. Immunocytochemistry for Claudin-18 and Maspin in biliary brushing cytology increases the accuracy of diagnosing pancreatobiliary malignancies. Cytopathology. 2017;28:116–21. https://doi.org/10.1111/cyt.12368.

    Article  CAS  PubMed  Google Scholar 

  38. Dudley JC, Zheng Z, McDonald T, Le LP, Dias-Santagata D, Borger D, et al. Next-generation sequencing and fluorescence in situ hybridization have comparable performance characteristics in the analysis of pancreaticobiliary brushings for malignancy. J Mol Diagn. 2016;18:124–30. https://doi.org/10.1016/j.jmoldx.2015.08.002.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Weill-Cornell Medicine, New York Presbyterian Hosptial, New York, NY, USA

    Abha Goyal

Authors
  1. Abha Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abha Goyal .

Editor information

Editors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Weill-Cornell Medicine, NewYork Presbyterian Hospital, New York, NY, USA

    Abha Goyal

  2. Department of Pathology and Laboratory Medicine, Weill-Cornell Medicine, NewYork Presbyterian Hospital, New York, NY, USA

    Rema Rao

  3. Department of Pathology and Laboratory Medicine, Weill-Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA

    Momin T. Siddiqui

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Goyal, A. (2019). Bile Duct Brush Cytology. In: Goyal, A., Rao, R., Siddiqui, M. (eds) Pancreas and Biliary Tract Cytohistology. Essentials in Cytopathology, vol 28. Springer, Cham. https://doi.org/10.1007/978-3-030-22433-2_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-22433-2_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-22432-5

  • Online ISBN: 978-3-030-22433-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation