Bile Duct Brush Cytology

  • Abha GoyalEmail author
Part of the Essentials in Cytopathology book series (EICP, volume 28)


The determination of biliary strictures as benign or malignant is challenging in clinical practice. It requires a multidisciplinary approach comprising of clinical, imaging, and pathologic findings. Most of the biliary strictures are malignant, the most common malignancies being pancreatic ductal adenocarcinomas, cholangiocarcinomas, and peri-ampullary carcinomas. The diagnosis of malignancy aids in early treatment if the tumor is resectable. If unresectable, it helps in planning palliative care. Endoscopic retrograde cholangiopancreatography (ERCP)-guided brush cytology is considered the preferred method for tissue diagnosis of biliary strictures. Histologic sampling in this area can be problematic due to high rate of complications and associated artifacts from tissue crushing and distortion. The sensitivity of brush cytology for diagnosing malignancy ranges from 30% to 89% as per various studies. However, its specificity for malignancy approaches 100%. This chapter discusses the nuances of cytologic features of bile duct brushings (BDB), the diagnostic challenges, and the ancillary studies that can assist in their evaluation.


Bile duct brushing Bile duct stricture Cholangiocarcinoma Primary sclerosing cholangitis (PSC) Reactive changes Bile duct stent 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory MedicineWeill-Cornell Medicine, New York Presbyterian HosptialNew YorkUSA

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