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

Abstract

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