Intraoperative bile cytology of the dysplasia-carcinoma in situ sequence of gallbladder carcinoma

Abstract

Background: The preoperative diagnosis of noninvasive and early carcinoma of the gallbladder is considered to be both difficult and exceptional. In the current study, the authors conducted a cytologic analysis of bile in the intraoperative diagnosis of clinically unsuspected gallbladder carcinoma.

Methods: Bile samples collected from 40 patients at the time of elective cholecystectomy were centrifuged. Smears prepared from the sediments were stained with May-Grünwald-Giemsa and Papanicolaou stains. Lesions were categorized as hyperplasia with or without metaplasia, dysplasia, carcinoma in situ, and invasive carcinoma. Cytologic diagnoses were compared with histopathology.

Results: Two cases of carcinoma in situ and one case of invasive carcinoma diagnosed on bile cytology were confirmed by histopathology. No false-positive diagnoses were made based on cytologic examination of aspirated bile. Cytohistologic concordance in cases of hyperplasia, dysplasia, and chronic cholecystitis varied from 56-60%.

Conclusions: Intraoperative bile cytology was found to be a reliable method for the detection of in situ and early invasive carcinoma of the gallbladder.