BRUSH CYTOLOGY IN PANCREATOBILIARY MALIGNANCIES :STILL A USEFUL TOOL

Dr. Sanjay Kumar; Dr Neetu Kumar; Dr Pravin Borsadia; Dr Sandesh Sharma; Dr Varun Khandagale; Dr Kshitij Kumar

Volume : VII, Issue : II, February - 2018

BRUSH CYTOLOGY IN PANCREATOBILIARY MALIGNANCIES :STILL A USEFUL TOOL

Dr. Sanjay Kumar, Dr Neetu Kumar, Dr Pravin Borsadia, Dr Sandesh Sharma, Dr Varun Khandagale, Dr Kshitij Kumar

Abstract :

Objectives: TO assess the diagnostic yield of cytology, cholangioscopy, cholangioscopic biopsy and CA–19.9 in patients with malignant obstructive jaundice

Methodology: We conducted a retrospective analysis of consecutive cases of malignant obstructive jaundice/ GB mass/ Pancreatic mass, based on imaging and subjected them to the appropriate cytological examination and CA 19–9 assays and compared them with clinical, radiological and surgical diagnosis.

Results: The diagnostic yield was 61.5% (48/78). It was more for Brush smear (70%) as compared to Bile (50%). Spyglass cholangioscopy was suggestive of malignancy in 8/10, out of which spybite was taken in 2, both of which turned out to be positive. But we switched over to ush cytology as we found spy forceps difficult to use. CA 19.9 levels were available in 30 of 48 confirmed cases and were >500 in 20, between 100 & 500 in 2, between 30 & 100 in 6 and normal in 2. But CA 19.9 levels were also raised to >500 in 4/5 cases of CBD stones with cholangitis

Conclusion: Brush cytology in our set up is a very good tool and yield is about 70% .Very high levels of ca 19.9 are suggestive but cannot be relied upon as a sole evidence of malignancy. Spyglass images strengthen the diagnosis of cholangiocarcinoma but spybite is not a practical tool as passage through spy scope is very difficult and time consuming