Biliary brushing during endoscopic retrograde cholangiography may allow the diagnosis of cancer.
However, this technique is limited by a low sensitivity.
Dr Jean Marc Dumonceau and colleagues from Switzerland compared the cellular and diagnostic yields of a new sampling method with those of brushing for the diagnosis of cancer.
|The new method had a higher sensitivity for cancer detection|
|The American Journal of Gastroenterology|
The investigative team evaluated 60 consecutive patients with a suspected malignant obstruction of the common bile duct in a consecutive, nonrandomized order.
The patients underwent sampling during endoscopic retrograde cholangiography using.
The team allocated 30 study patients to the new method, and 30 as controls who underwent brushing.
A final diagnosis of cancer was made in 73% of study patients and 70% of control patients.
At the end of the study period, all smears were interpreted at cytopathological examination in a blind and random fashion for cellularity and diagnosis.
‘Highly atypical' and ‘malignant' diagnoses were considered as indicative of cancer.
Compared with biliary brushing, the investigators found that the new method provided a high cellular yield in more cases.
The team noted that the new methods also provided a higher sensitivity for the detection of cancer, and a higher diagnostic accuracy.
The investigative team observed that specificity for the detection of cancer was 100%.
The 30-day complication rate observed with the new method was 3%.
Dr Dumonceau's team concluded, “Significantly higher cellular and diagnostic yields can be obtained at endoscopic retrograde cholangiography in patients with suspected malignant biliary stricture by combining stricture dilation and a grasping basket compared with brushing.”