Clinical Usefulness of Bile Cytology Obtained from Biliary Drainage Tube for Diagnosing Cholangiocarcinoma / 대한소화기학회지

BACKGROUND/AIMS: Biliary drainage is performed in many patients with cholangiocarcinoma (CCA) to relieve obstructive jaundice. For those who have undergone biliary drainage, bile cytology can be easily performed since the access is already achieved. This study aims to determine the clinical usefulness of bile cytology for the diagnosis of CCA and to evaluate factors affecting its diagnostic yield. METHODS: A total of 766 consecutive patients with CCA underwent bile cytology via endoscopic nasobiliary drainage or percutaneous transhepatic biliary drainage from January 2000 to June 2012. Data were collected by retrospectively reviewing the medical records. We evaluated the diagnostic yield of bile cytology with/without other sampling methods including brush cytology and endobiliary forcep biopsy, and the optimal number of repeated bile sampling. Several factors affecting diagnostic yield were then analyzed. RESULTS: The sensitivity of bile cytology, endobiliary forceps biopsy, and a combination of both sampling methods were 24.7% (189/766), 74.4% (259/348), and 77.9% (271/348), respectively. The cumulative positive rate of bile sampling increased from 40.7% (77/189) at first sampling to 93.1% (176/189) at third sampling. On multivariate analysis, factors associated with positive bile cytology were perihilar tumor location, intraductal growing tumor type, tumor extent > or =20 mm, poorly differentiated grade tumor, and three or more samplings. CONCLUSIONS: Although bile cytology itself has a low sensitivity in diagnosing CCA, it has an additive role when combined with endobiliary forceps biopsy. Due to the relative ease and low cost, bile cytology can be considered a reasonable complementary diagnostic tool for diagnosing CCA.

Diagnostic criteria for malignancy in bile cytology and its usefulness

Fifty three bile specimens from 42 patients were reviewed to assess the diagnostic role of the bile cytology and to define more reliable cytologic indicators of malignancy. Forty three bile specimens came from 34 patients with malignant biliary strictures and 10 bile specimens were from eight patients with benign conditions. There were no false positives. The diagnostic specificity of bile cytology was 100% while diagnostic sensitivity was 55.8%. Overall diagnostic accuracy was 64.2%. We identified four key criteria as cytologic indicators of malignancy among 20 variables by using multiple regression analysis: loss of honeycomb arrangement, hyperchromatism, increased N/C ratio, and coarse chromatin. When bile specimens with three or more of these four criteria are thought to represent malignancy, the sensitivity of diagnosis of malignancy was 65.2%, specificity was 90% and diagnostic accuracy was 69.8%.

Enfermedad vesicular inaparente o microlitiasis en pacientes con pancreatitis aguda: una situación clínica frecuente / Occult gallbladder disease or microlithiasis in patients with acute pancreatitis: a frequent clinical situation

Patients admitted with the diagnosis of AP to a clinical hospital were included in the study. According to an abdominal ultrasound study, patients were classified as having or not cholelithiasis. A duodenal biliary drainage was performed in 15 patientes with AP and without gallbladder stones. Results: Patients without cholelithiasis had recurrent AP more often than patients with biliary AP (53 and 3.3 percent respectively). Excessive alcohol ingestion did not rule out the possibility of biliary etiology. In 6 patients, the analysis of duodenal bile showed cholesterol crystals, and cholecystectomy confirmed the existence of gallbladder disease in 54. All of them remained asymptomatic during a follow-up period of four years. One patient refused surgery, with subsequent development of galls tones and recurrent episodes of AP. In other 4 patients, gallbladder disease was confirmed by percutaneous gallbladder puncture or during cholecystectomy. No recurrence of AP were observed during the follow-up. Conclusions: Microlithiasis or "occult" gallbladder disease accounts for at least 67 percent of the original "non-biliary" AP. Duodenal bile analysis is a useful and necessary technique for the evaluation of patients with "non-biliary" actue pancreatitis. Careful clinical and echographic follow-up of this subgroup of patients with AP is mandatory

value of bile cytology in the diagnosis and early detection of malignancy in patients with obstructive jaundice

Bile was aspirated from 20 patients suffering from obstructive jaundice [10- males and 10 females] during endoscopic cholangiography [ERCP]. The patients were assessed clinically, by laboratory investigations, abdominal ultrasonography, ERCP, operative biopsy and by cytology. This is to determine the presence of malignancy as an underlying cause for the obstruction and to evaluate the diagnostic accuracy of bile cytology obtained during ERCP. The results of 19 cases were divided into two main groups where group A consisted of 10 malignant cases and 5 benign cases. One case showed false positive diagnosis and no false negative. Group B included 4 atypical smears which were considered benign until proved otherwise [I proved histologically benign the others were found to be malignant]. The sensitivity calculated for group A was 100% and 75% for group B, the specificity was 83.3% for A and 85.7% for B. The diagnostic accuracy was 93.3% for A and 78.9 for group B. The results of this pilot study are quite encouraging with respect to the reliability of diagnosis of bile samples particularly in association with ERCP, it can be considered as a simple reliable, rapid method for preoperative evaluation of patients with obstructive jaundice and for the early detection of malignancy in screening programs

cytological features of stagnant bile in patients with obstructive biliary disorders

Nineteen bile samples were aspirated during endoscopic cholangiography [ERCP] for patients with obstructive jaundice. The patients were assessed clinically, by laboratory investigations, abdominal ultrasonography, ERCP, operative biopsy and by cytology to determine the cause for the obstruction and to evaluate the diagnostic celluiar features of bile cytology obtained during ERCP. The results of 19 cases consisted of 10 malignant cases, 5 benign and 4 atypical smears. The cytological features differentiating benign from malignant lesions gave quite encouraging results with respect to the reliability of diagnosis of bile samples particularly in association with ERCP, sensitivity 76.9%, specificity 87.5% and diagnostic accuracy 82.6%. Such a method can therefore be considered as a simple reliable, rapid method for preoperative evaluation of obstructive jaundice patients and for the early detection of malignancy in screening programs

Bacterias mas frecuentes en colecistitis / Most frequent bacterias in cholecystitis

Las enfermedades de vesícula y tracto biliar predominan en un amplio sector de nuestra comunidad: con su variada presentación en forma de colecistitis calculosa aguda y crónica, coledocolitiasis y escasamente cancer de vesícula, de vias biliares. no se cuentan en nuestro medio con estadísticas que reporten al pocenataje y frecuencia de presentación de estos cuadros clínicos, menos estudios microbiológicos de bilis en Cochabamba. La presente investigación incluye un trabajo prospectivo realizado en el Hopsital Viedma, cuyo propósito es la determinación de bacterias en bilis y sensibilidad que permitira un esquema de tratamiento antibiótico y de este modo prevenir las consecuencias catastroficas de una complicación. De este modo se estudiarón a 18 pacientes de ambos sexos con patología de vesícula y vías biliares mediante cultivos a traves de punción directa.

La Cirugía biliar y el papel de la citología en el diagnostico y detección de neoplasias de la vía biliar / Biliary surgery and the cytology in diagnosis and neoplasms detection in the pathways biliar

Se realiza el estudio prospectivo de 100 casos consecutivos de bilis vesicular y coledociana tomadas durante el acto operatorio electivo de vías biliares que ingresaron al quirófano con el diagnóstico de colecistitis crónica calculosa. Se obtuvo 3 por ciento de positividad sin falsos positivos. Los PAP que resultaron negativo pero que después se demostró tumor, se trató de neoplasias que no estaban en contacto con bilis. La alta confiabilidad de este procedimiento, hace surgir su utilización rutinaria junto con la metodología de investigación de la pieza operatoria como lo hace la escuela japonesa. El trabajo en equipo multidisciplinario es fundamental.