Diagnostic Yield of Brush Cytology for Biliary Strictures During ERCP

Biliary duct narrowing is one of the most common problems that is observed during endoscopic retrograde cholangiopancreatography (ERCP) procedures, espe-1 cially in patients with obstructive jaundice.These strictures may originate from a group of causes, like cancerous neoplasms, benign inflammatory conditions, iatrogenic 2 injuries, and primary sclerosing cholangitis.A precise and timely diagnosis of these strictures is must for the purpose of fashioning a suitable intervention.While this approach will contribute to maximizing patient outcomes, it will also ensure the avoidance of needless, 3 invasive procedures.The technique of brushing cytology was introduced to ease up the tissue getting during pathological evaluation by having less load on the technician's procedures, the safety conferred on the technician, and the fact that the material is easily available to the technician.During the course of the ERCP, the brush is introduced into the biliary ductal system through the endoscope channel, which has a working channel that in turn permits the collection of the cellular material from within the stricture.This method provides several benefits that alternative techniques, for instance, intraductal bile aspiration cytology, endobiliary forceps biopsy, and fine needle aspiration (FNA), don't have, like a less complex and safer operation as well as a larger area of the stenosis 4 that is being sampled.Although cytology of brushing is a widely used diagnostic method, debate arises about the sensitivity of cytology of brushing to detect cancer within biliary strictures.Sensitivity, as reported in studies, has broadly oscillated around 40% of the measured values.This is likely due to a variety of factors, for instance, patients' AbstractObjective: 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.