Diagnostic Yield of Brush Cytology for Biliary Strictures During ERCP

Objective: The aim of this study was to assess the yield of brush cytology in patients with biliary strictures detected at ERCP when a systematic approach is used and when a dedicated pathologist performs the cytological analysis. Methods: A retrospective study was conducted to assess the accuracy of diagnostic brush cytology during ERCP for biliary stenosis. The study included patients with biliary strictures identified during ERCP who experienced biliary brushing cytology. We reviewed all ERCPs carried out from January, 2021 to June, 2024 in the department of Gastroenterology at Arif Memorial Teaching Hospital Lahore and Fatima Memorial Hospital Lahore. During a standard ERCP, a brush specimen was collected, and the cytology sample was promptly transferred to a glass slide by the nursing staff, who smeared the cellular material directly from brush onto the slide. The slides were then immersed in a fixative (alcohol). Subsequently, a dedicated pathologist performed the cytological analysis and categorized the samples in 3 categories: positive for malignancy, negative for malignancy, or invalid. Results: A total of 126 patients underwent brushing for cytology in strictures seen at ERCP. There were 44 females and 82 males; 33.3% of the patients were between 45 and 65 years of age and 66.7% were older than 65 years. Overall sensitivity was 62.0% (78.0% in males and 53.0% in females). Conclusion: Study concluded that brushing the biliary strictures for cytology is a sensitive method for the diagnosis of biliary malignancies. Using a rapid fixing technique and single dedicated pathologist reviewing the slides appears to be the reason for this high yield.