The usefulness of saline-irrigated bile for the intraoperative cytologic diagnosis of tumors and tumorlike lesions of the gallbladder

Intraoperative cytology was performed for 48 patients with polypoid lesions (36 benign and 12 malignant) of the gallbladder. The cytologic samples consisted of pure bile from 48 patients and diluted bile collected by saline irrigation from 29 patients. Pure bile gave 32 correct diagnoses (67%) and 14 diagnoses of inadequate material (29%), which contained few nondegenerated cells and made microscopic diagnosis unreliable. Inadequate material was frequently obtained in cases of cholesterol polyp (45%), tubular or papillary adenomatous carcinoma (50%) and polypoid carcinoma (17%), but not in cases of inflammatory polyp (0%). On the other hand, cytologic study of bile samples obtained by saline irrigation showed no inadequate material and only one false negative, from a case in which the cancerous focus was mostly covered with nonneoplastic epithelium. These results imply that saline irrigation succeeded in collecting many nondegenerated cells newly exfoliated from the wall of lesions and the technique is useful in the intraoperative cytologic study of polypoid gallbladder lesions.