Year 2025 / Volume 117 / Number 8
Original
Diagnostic yield of biliary brush cytology via endoscopic retrograde cholangiopancreatography: a 7-year tertiary center experience

447-454

DOI: 10.17235/reed.2025.11158/2025

Beatriz Gros, Paloma Elma Alañón Martínez, Marina Orti Cuerva, Ana Aparicio-Serrano, Elma Gallego Jiménez, Ana Santos Lucio, María Pleguezuelo Navarro, Antonio Hervás Molina, Francisco Javier Serrano Ruiz,

Abstract
Background: biliary brushing cytology during endoscopic retrograde cholangiopancreatography (ERCP) was used to assess the nature of a biliary stricture. Its low sensitivity challenges the exclusion of malignancy through this technique. The aim of this study was to evaluate the diagnostic yield of brush cytology in biliary strictures and to identify predictive factors associated with a positive diagnosis of malignancy. Methods: an observational retrospective study was performed in a tertiary center. All adult patients undergoing a biliary brushing during ERPC from 2016 to 2022 were included. Logistic regression analyses were performed to identify predictive factors for positive brush cytology. Results: a total of 5,309 patients underwent ERCP within the evaluated period. Out of these, biliary brushing was performed in 518 patients, including 568 cytology samples; 57.7 % (299) were male, with a median of 74 (64-84) years of age. Within the cohort, 24 % (126) had benign strictures and 76 % (392) had malignancy, of which the most common etiologies were pancreatic cancer 42.5 % (220/518), followed by cholangiocarcinoma 22.6 % (117/518). The sensitivity, specificity, positive predictive value, and negative predictive value were 48 %, 98 %, 98 % and 37 %, respectively. Sensitivity was 45 % and 52 % in pancreatic adenocarcinoma and cholangiocarcinoma, respectively. Older age (OR 1.02, 95 % CI: 1.01-1.03, p = 0.01) and higher bilirubin levels (OR 1.05, 95 % CI: 1.03-1.08, p < 0.001) were independent predictors for brush cytology positivity. The post-ERCP complication rate was 9.7 % (45/518). Conclusions: biliary brushing cytology during ERCP is a safe procedure with a low sensitivity and high specificity. Older age and higher bilirubin levels are associated with positive biliary cytology.
Lay Summary
Detecting malignancies in biliary strictures is crucial due to their high lethality, as early diagnosis allows for timely treatment. Endoscopic retrograde cholangiopancreatography (ERCP) is often required to perform biliary drainage, and during the same procedure, biliary brush cytology can be performed to collect cells for analysis without increasing the complexity of the technique. However, this method has low sensitivity, meaning it may miss some cancers, despite its high specificity. This study analyzed 518 patients who underwent biliary brush cytology between 2016 and 2022 at a tertiary hospital. The results showed a specificity of 96.9%, meaning a positive cytology result is highly reliable. However, sensitivity was only 48.5%, meaning almost half of the malignancies were not detected. Sensitivity was particularly low for pancreatic cancer (45.5%) and cholangiocarcinoma (53%). Two factors were associated with a higher likelihood of a positive cytology result: older age and higher bilirubin levels, likely due to more advanced disease. Although biliary brush cytology is a safe and cost-effective method, its low sensitivity highlights the need for additional diagnostic strategies, to improve cancer detection when these are available.
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Gros B, Alañón Martínez P, Orti Cuerva M, Aparicio-Serrano A, Gallego Jiménez E, Santos Lucio A, et all. Diagnostic yield of biliary brush cytology via endoscopic retrograde cholangiopancreatography: a 7-year tertiary center experience . 11158/2025


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Publication history

Received: 16/02/2025

Accepted: 24/04/2025

Online First: 12/05/2025

Published: 24/07/2025

Article revision time: 42 days

Article Online First time: 85 days

Article editing time: 158 days


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