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Types of biopsy

Brush and Wash Cytology: — How Cells Are Sampled Without a Cut

If your doctor has mentioned brush or wash cytology, you are having a procedure that collects cells from inside the body through a scope already in place — no separate incision, no needle. This page explains what each method involves, where they are used, and what the results can and cannot tell you.

Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed September 2026

  • Done through a scope — Both methods use a scope already passed into the airway, bile duct or urinary tract. No additional cut is made to collect the sample.
  • Two different techniques — Brushing physically scrapes cells from the tissue surface. Washing flushes the area with saline and retrieves the cells that detach.
  • Used where needles cannot easily reach — These techniques suit areas inside tubes and ducts — the bronchi, bile duct, or ureter — where a standard needle biopsy is not straightforward.
  • Results read by a pathologist — A cytopathologist examines the collected cells under a microscope and reports whether they appear normal, suspicious, or malignant.
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Brush and wash cytology collect cells from inside the body through a scope, with no separate incision. Brush cytology scrapes cells from the tissue surface using a small brush. Wash cytology flushes the area with saline and retrieves the cells that wash free. Your doctor chooses between them based on where the sample is needed.

What is the difference between brush cytology and wash cytology?

Brush cytologyWash cytology
How the sample is takenA small brush on a thin wire is passed through the scope and rubbed against the tissue surface to collect cells directlySaline is flushed into the area through the scope and then aspirated back, carrying shed cells with it
Common locationsAirways (bronchi), bile duct, ureter and renal pelvisAirways, bile duct, urinary tract — often used alongside brush cytology in the same session
What you feel during the stepThe brushing adds little to the scope procedure already under wayMinimal — a brief flush of fluid through the scope already in place
Reliability for detecting malignancyGenerally higher sensitivity than wash alone; still lower than tissue biopsyAdds diagnostic yield when combined with brush; lower sensitivity when used alone
Can it replace a tissue biopsy?Not always — it samples surface cells only, not the deeper tissue architectureNo — it supplements brush cytology or is used where direct brushing is not possible
When it tends to be chosenWhen the scope can reach and directly visualise the suspicious areaWhen direct brushing is not possible, or to increase the total number of cells collected

How is the sample actually taken?

Both techniques are performed through a scope that has already been passed to the target area — a bronchoscope for the airways, an ERCP catheter or choledochoscope for the bile duct, or a ureteroscope for the urinary tract. The sampling is a step within that existing procedure, not a separate one.

In brush cytology, the brush is passed through the working channel of the scope and rubbed against the area of concern. It is then withdrawn, and the cells are spread onto a glass slide or placed in preservative fluid and sent to the laboratory.

In wash cytology, saline is introduced through the scope, flushed across the suspicious area, and then aspirated back. The retrieved fluid contains cells that have shed from the lining. The two methods are often performed in the same sitting to maximise the number of cells available for analysis.

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How reliable is cytology compared to a tissue biopsy?

Cytology examines individual cells, not the architecture of the surrounding tissue. Some diagnoses — particularly distinguishing between tumour subtypes — depend on seeing how cells are arranged in layers and in relation to each other, which only a tissue sample can show.

For detecting whether malignant cells are present, combining brush and wash sampling improves the proportion of cases identified compared to either method used alone. Guidance from the ASGE Standards of Practice Committee and the British Thoracic Society both recognise the improved yield from combined sampling in their respective fields.

A negative cytology result does not always exclude cancer. If imaging, clinical findings and cytology point in different directions, your team may recommend a tissue biopsy, repeat sampling, or further investigation. Your oncologist will explain what the result means in the context of your full picture.

What should you tell your team before the procedure?

  • Any blood-thinning medicines you take — including aspirin, warfarin, clopidogrel, or newer oral anticoagulants
  • Herbal supplements or traditional medicines, as some affect bleeding risk
  • Any previous reaction to sedation or general anaesthesia
  • Breathing problems, chronic lung disease, or heart conditions — these affect how sedation is managed
  • Whether you are pregnant or may be pregnant
  • Any implanted device such as a pacemaker or defibrillator, particularly if fluoroscopy will be used to guide the scope

Did you know?

When brush cytology and wash cytology are performed together at the same endoscopic session, the combined approach identifies a higher proportion of malignant cases than either technique used alone.

Most centres performing ERCP for suspected biliary malignancy now use both methods as routine rather than choosing between them, following ASGE Standards of Practice Committee guidance.

Source: ASGE Standards of Practice Committee — The role of ERCP in diseases of the biliary tract and the pancreas

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Common questions

Frequently asked questions

What is the difference between cytology and a biopsy?

Cytology examines individual cells collected from a tissue surface or fluid. A biopsy removes a small piece of tissue so the laboratory can examine how cells are structured and arranged in depth. Cytology is faster and involves less disruption, but tissue biopsy often provides more information — particularly for identifying tumour type and the extent of invasion. Cytology is used when the target area, such as inside a duct, makes tissue removal difficult or risky.

Will I be sedated or anaesthetised for the procedure?

It depends on which scope is used and your overall health. Bronchoscopy is usually done under conscious sedation — you are deeply relaxed but not fully anaesthetised. ERCP for bile duct sampling may use sedation or general anaesthesia. Urinary tract procedures are often done with local anaesthetic gel and light sedation. Your proceduralist will explain the specific plan before you sign consent.

How long will the procedure take?

The brushing or washing step itself takes only a minute or two within the procedure. The overall scope procedure is longer — anywhere from fifteen minutes to an hour or more depending on the site and whether other steps, such as stenting or tissue biopsy, are performed at the same time. Ask your team how long you should plan to be in the department, including recovery time after sedation.

When will I get my cytology results?

Results typically take a few days to about a week, depending on the laboratory and whether special staining is needed. Your oncologist or the referring doctor will contact you to discuss the findings. If you have not heard within the timeframe your team mentioned, call the clinic and ask rather than waiting without a clear timeline.

What if the cytology is negative but my doctor still suspects cancer?

A negative result means malignant cells were not identified in that particular sample — not necessarily that cancer is absent. Cytology sensitivity is imperfect, and a small or early tumour may not shed enough detectable cells. If your imaging or clinical findings still point toward cancer, your doctor may recommend a tissue biopsy, repeat sampling, or further imaging. Your team will explain the reasoning for whatever next step is recommended.

Is brush cytology used to diagnose lung cancer?

Yes, for cancers that arise in the central airways and are directly visible through a bronchoscope. Brush cytology through bronchoscopy is a standard part of assessment for central airway tumours. It is less useful for peripheral tumours beyond the bronchoscope's reach — those are typically sampled by CT-guided needle biopsy or endobronchial ultrasound-guided procedures. Your pulmonologist or oncologist will explain which approach suits the location of your lesion.

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