Cytologic Diagnosis of Bile Duct Strictures: Brush or Scrape?

Excerpt

Achieving a pathologic diagnosis for biliary strictures short of surgical resection is notoriously difficult, which in turn impairs the ability to deliver optimal clinical care. Confidence in classifying a biliary stricture as benign is limited since biopsies of strictures ultimately proven to be malignant yield the correct diagnosis only about half the time, an uncertainty which in turn leads to overtreatment. Approximately 10–15% of biliary strictures suspicious for malignancy are benign when analyzed following surgical resection, comprising a wide array of histopathologic entities [1, 2]. As many medical oncologists are reluctant to systemically treat unresectable biliary strictures without a pathologic confirmation of malignancy, the inability to accurately diagnose these strictures also results in undertreatment. Furthermore, in the absence of a pathologic diagnosis, the treatment given may not always be appropriate since systemic treatment may be targeted against a suspected malignancy different from the one actually present (i.e., metastatic disease or hepatocellular carcinoma mimicking cholangiocarcinoma). Similarly, even when the correct histopathologic diagnosis is targeted, the inability to uniformly obtain adequate tissue limits the ability to provide personalized therapy. …