Diagnostic significance of bile cytology in obstructive jaundice

Cytological examination of exfoliated cells in the bile or irrigated fluid from a percutaneous transhepatic choledochal drainage (PTCD) tube and other jaundice-reducing fistula was performed in 59 patients with obstructive jaundice. Malignant cells were found in 22 of 27 patients with choledochal cancer, 50 of 17 patients with pancreatic cancer, 3 of 6 patients with gallbladder cancer, and one of 5 patients with other malignancies. Exfoliated malignant cells were found at a higher rate in the washed fluid of the PTCD tube than in the pure bile aspirated from the PTCD tube. Half of the positive cases were diagnosed as such upon the first cytological examination, and the remaining in second or subsequent cytological examinations. The cytological appearance of cells in the washed fluid or bile reflected the type of cancer cells found by touch-smear of the lesion and also the histological type. This method requires no special technique and facilitates accurate diagnosis in patients with malignant lesion of the choledochal duct.