EVALUATION OF MALIGNANT BILIARY TRACT STRICTURES WITH ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY GUIDED BRUSH CYTOLOGY
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Keywords
evaluating biliary, pathological, ERCP, cytological characteristics, adenocarcinoma
Abstract
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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Ravi Keshari
DM Gastro, Department of Gastroenterology, Aasav Hospital, Muzaffarpur, Bihar, India