Bile cytology. Diagnostic role in the management of biliary obstruction

Thirty satisfactory bile specimens from 21 patients (13 with cancer and 8 with benign conditions) were reviewed to assess the diagnostic role of bile cytology in the management of biliary obstruction. Smears were malignant in 5 instances, suspicious in 1, atypical in 2 (8 in the positive group) and negative in 22. There were no false positives. The diagnostic sensitivity was 38%, specificity 100% and overall accuracy 57%. Of interest were (1) hepatocellular carcinoma, causing obstruction in three patients; (2) metastatic colonic adenocarcinoma, causing obstruction in another instance; (3) positive cytodiagnosis in a patient who developed biliary stricture following laparoscopic cholecystectomy; and (4) detection of acidfast bacilli in bile from a case of tuberculous pseudotumor mimicking a hepatic malignancy. Bile cytology is a simple, inexpensive means of obtaining tissue confirmation of neoplastic and specific inflammatory causes of biliary obstruction. It is a useful adjunct to other techniques in this era of fiberoptic diagnostic procedures. Cell block sections should be prepared whenever possible.