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Ravi Keshari


evaluating biliary, pathological, ERCP, cytological characteristics, adenocarcinoma


Introduction:  The gold standard method for evaluating biliary tract lesions is endoscopic retrograde cholangiopancreatography (ERCP). The patient who has a benign condition must not undergo extensive surgery in order to receive a prompt diagnosis. In our system, obstructive jaundice is frequently caused by restrictions brought on by malignancy. In these situations, stenting or papillotomy are used to release the block by performing an ERCP operation. Biliary strictures that are thought to be cancerous but lack a tissue diagnosis, or "indeterminate strictures," frequently present diagnostic challenges. To determine the next step in the management procedure, pathological confirmation is preferred. The diagnosis of biliary tract lesions is made safe and accurately by brush cytology.

Materials and method:  The research was conducted prospectively over a year. 40 cases of malignant strictures with obstructive jaundice who underwent ERCP for diagnosis and therapy were collected for cytological study. To determine mild basal cytomorphology, five examples of benign stricture were examined. These smears were produced and examined for typical cytological characteristics.

Results: A prolonged follow-up was found 28 of the 38 occurrences involved cancer, five had reactive responses, and five had NOS-suspicious results. 20% of the specimens included gall bladder cancer, 12.5% contained periampullary cancer, and 5% contained pancreatic ductal adenocarcinoma at examination. Pancreatic ductal adenocarcinoma was detected by cytology with a detection rate of 100%, cholangiocarcinoma by 85.7%, periampullary carcinoma by 80%, and gall bladder carcinoma by 58.3%. In general, brush cytology was 73.6% sensitive. Indicators of malignancy included increasing cellularity, reduced polarity, nuclear hyperchromasia, aberrant nuclear shape, and nucleolar importance in the cytomorphological analysis.

Additional criteria for the cancer diagnosis were nuclear variation, background abnormal cells, and multinucleated cells.d a total of six more instances.

Conclusions: The current investigation provides evidence that ERCP-guided brushing, When assessing instances of malignant biliary tract strictures, cytology is a sensitive approach.

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1. Kurzawinski T, Deery A, Davidson BR. Diagnostic value of cytology for biliary stricture. BrJ Surg 1993; 80: 414-21.
2. Karvonen J, Kairisto V, Grönroos JM. Stone or stricture as a cause of extrahepatic cholestasis - Do liver function tests predict the diagnosis? Clin Chem Lab Med. 2006;44:1453-56.
3. Gupta AK, Singh A, Goel S, Tank R. Profile and pattern of obstructive jaundice cases from a tertiary care teaching hospital of Uttar Pradesh. International Surgery Journal. 2017;4(2):743-46.
4. Sharma MP, Ahuja V. Aetiological spectrum of obstructive jaundice and diagnostic ability of ultrasonography clinician’s perspective. Tropical Gastroenterology. 1999;20:67-69.
5. Madhu MP, Agarwal V, Soni A, Pokharna RK, Nijhawan S, Sharma G, et al. Etiological spectrum of extra hepatic biliary obstructive (EHBO) at a tertiary care centre in Northern India. Tropical Gastroenterology. 2015;36(2):142-43.
6. Ferrucci JT, Wittenberg J, Margolies MN, Carey RW. Malignant seeding of the tract after thin-needle aspiration biopsy. Radiology 1979; 130: 345-6.
7. Warshaw AL. Implication of peritoneal cytology for staging of early pancreatic surgery. AmJ Surg 1991; 161: 26-9.
8. Thuluvath PJ, Rai R, Venbrux AC, Yeo CJ. Cholangiocarcinoma: a review. Gastroenterologist. 1997;5(4):306-15.
9. Layfield LJ, Wax TD, Lee JG, Cotton PB. Accuracy and morphologic aspects of pancreatic and biliary duct brushings. Acta Cytologica. 1995;39:11-18.
10. Logrono R, Wong JY. Reporting the presence of significant epithelial atypia in pancreaticobiliary brush cytology specimens lacking evidence of obvious carcinoma: impact on performance measures. Acta Cytol. 2004;48: 613-621.
11. Leach SD, Rose JA, Lowy AM, et al. Significance of peritoneal cytology in patients with potentially resectable adenocarcinoma of the pancreatic head. Surgery. 1995;118:472-78.
12. Foutch PG. Diagnosis of cancer by cytological methods performed during ERCP. Gastrointest Endosc. 1994;40:249-52.
13. Kurzawinski T, Deery A, Davidson BR. Diagnostic value of cytology for biliary stricture. Br J Surg. 1993;80:414-21.
14. Gupta M, Pai RR, Dileep D, Gopal S, Shenoy S. Role of biliary tract cytology in the evaluation of extrahepatic cholestatic jaundice. Journal of Cytology. 2013;30(3):162-68.
15. Mahmoudi N, Enns R, Amar J, AlAli J, Lam E, Telford J. Biliary brush cytology: Factors associated with positive yields on biliary brush cytology. World J Gastroenterol. 2008;14:569-73
16. Adamsen S, Olsen M, Jendresen MB, Holck S, Helthoj A. Endobiliary brush biopsy: Intra- and interobserver variation in cytological evaluation of brushings from bile duct strictures. Scand J Gastroenterol. 2006;41:597-603.
17. Draganov PV, Chauhan S, Wagh MS, Gupte AR, Lin T, Hou W, Forsmark CE. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term followup study. Gastrointest Endosc. 2012;75:347-53.
18. De Peralta-Venturina MN, Wong DK, Purslow MJ, Kini SR. Biliary tract cytology in specimensobtained by direct cholangiographic procedures: a study of 74 cases. Diagn Cytopathol. 1996;14:334-48.
19. Foutch PG, Kerr DM, Harlan JR, Kummet TD. A prospective, controlled analysis of endoscopic cytotechniques for diagnosis of malignant biliary strictures. Am J Gastroenterol. 1991;86:577-80.
20. Avadhani V, Hacihasanoglu E, Memis B, Pehlivanoglu B, Hanley KZ, Krishnamurti U, et al. Cytologic predictors of malignancy in bile duct brushings: a multireviewer analysis of 60 cases. Modern Pathology. 2017;30:1273-86.
21. Okonkwo AM, De Frias DVS, Gunn R, Diaz L, Schindler S, Lal A, et al. Reclassification of “Atypical” Diagnoses in endoscopic retrograde cholangiopancreaticographyguided biliary brushings. Acta Cytologica. 2003;47:435-42.
22. 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.
23. Reid MD, Basturk O, Thirabanjasak D, Hruban RH, Klimsatra DS, Bagci P, et al. Tumor infiltrating neutrophils in pancreatic neoplasia. Mod Pathol. 2011;24:1612-19.
24. Ponchon T, Gagnon F, Berger F. 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.
25. Chen L, Huang K, Himmelfarb EA, Zhai J, Lai JP, Lin F, et al. Diagnostic value of maspin in distinguishing adenocarcinoma from benign biliary epithelium on endoscopic bile duct biopsy. Hum Pathol. 2015;46:1647-54
26. 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;149:1813-24.
27. Nanda A, Brown JM, Berger SH, Lewis MM, Barr Fritcher EG, Gores GJ, et al. Triple modality testing by endoscopic retrograde cholangiopancreatography for the diagnosis of cholangiocarcinoma. Ther Adv Gastroenterol. 2015; 8:56-65.