Report of the clinical study for methods to improve the diagnostic accuracy of bile cytology (1)

—Diagnostic bile cytology criteria—

Abstract

Objective : To improve the diagnostic accuracy of bile cytology, we defined more reliable cytological criteria for malignancy.
Study Design : Materials were 38 cytological bile juice specimens from 34 subjects with biliary strictures reviewed to evaluate the diagnostic cytological features of adenocarcinoma.
Results : We identified diagnostic criteria for malignancy as follows : irregularly overlapped nuclei, irregularly arranged nuclei, and irregular margins for clusters with over 50 cells, and enlarged nuclei, irregularly shaped nuclei, and abnormal chromatin for small clusters with fewer than 50 cells or isolated cells. Other notable findings were a necrotic background and cell clusters of different sizes. We note three important points : First, do not make a judgment from limited abnormalities. Second, even if morphological changes occur when bile juice is left as is, cytological diagnosis may be possible by observing the nuclear structure. Third, benign tumors and normal tissue display cytological features of equal internuclear distance and regularly arranged cytoplasm at cluster margins.
Conclusion : Applying these criteria to bile cytology is expected to improve diagnostic accuracy.