Diagnostic yield of brush cytology for biliary stenosis during ERCP

Abstract

Aim: to evaluate the diagnostic yield of brush cytology for biliary strictures detected on ERCP when a systematic approach is used. Patients and methods: data on 62 consecutive patients with a biliary stricture on ERCP were collected. Cytological samples were processed immediately after brushing in the endoscopy room, and all were analyzed by the same pathologist. For the statistical analysis specimens were classified as positive, negative, suspicious for malignancy (presence of atypias), and unsatisfactory for evaluation. Final diagnosis was based on either histopathologic (surgery or biopsies by other techniques) or clinical/radiographic diagnosis. Results: a total of 71 cytological specimens were included. Definite diagnosis was malignancy in 49 samples, and benign stricture in 22. Three samples were excluded because of insufficient material or processing artifacts. The sensitivity of biliary brushing was 62% (95% CI 0.47-0.77), specificity was 100%, positive predictive value was 100%, and negative predictive value was 58% (95% CI 0.43-0.75). When suspicious samples were included as malignant, sensitivity was 67% (95% CI 0.54-0.81) without changes in the remaining parameters. Eight patients underwent more than one ERCP. Repeated brush cytology exams in these patients yielded a definitive diagnosis in every case. Conclusions: brush cytology has intermediate sensitivity with a high specificity. A systematic approach with a dedicated pathologist and the inclusion of significant atypias as malignant results improves sensitivity. Due to its simplicity brush cytology should be performed in all cases of biliary strictures detected on ERCP, and in case of repeated ERCPs additional cytology brushings are recommended.

Combined brush cytology and stent placement in a single session for presumed malignant biliary stricture

“…In the present study, the sensitivity of brush cytology for presumed malignant biliary stricture was 83%, which was higher than those of previous English language published reports. [1][2][3][4][5][6][7] There are several factors that might contribute to this excellent sensitivity. First, all materials were immediately stained by the attending cytologist for the provisional diagnosis and a second brushing was performed whenever required.…”

“…Brush cytology during endoscopic retrograde cholangiopancreatography (ERCP) is a simple and common technique for establishing the diagnosis of biliary stricture; however, its sensitivity has been reported to be low, ranging from 35% to 72%. [1][2][3][4][5][6][7] Alternative techniques, such as stricture dilation followed by collecting materials using grasping basket or a combination of several techniques including brush cytology, have been reported with improved sensitivity. [8][9][10][11] However, these procedures are more complicated and traumatic.…”

İndetermine koledok darlıklarında fırça sitolojisinin değeri: Şişli Etfal deneyimi

“…Tıkanma ikteri ile başvuran hastalarda ERCP sırasında biliyer darlıklara sıkça rastlanmaktadır (1). Bu darlıkların etyolojisine yönelik işlem esnasında fırça sitolojisi alınması basit, hızlı ve güvenilir olması nedeniyle tercih edilmektedir.…”

“…Bu darlıkların etyolojisine yönelik işlem esnasında fırça sitolojisi alınması basit, hızlı ve güvenilir olması nedeniyle tercih edilmektedir. Ancak alınacak örneğin bazen yeterli olmayışı, yalancı negatiflik oranlarının yüksekliği, histopatolojik değerlendirmede inflamatu-var süreç malignite ayrımının yapılamaması gibi etkenler fırça sitolojisinin etkinliğini sınırlamaktadır (1)(2)(3)(4)(5)(6). Literatürde fırça sitolojisi ile ilgili yayınlarda örnek kalitesini artırmak amacıyla, işlemin tekrarlanması, aynı seansta yapılan biyopsi ile kombine edilmesi, fiksatör kullanılması, darlık içerisinden daha fazla sayıda geçiş yapılması veya bu işlem için geliştirilen farklı fırçaların kullanılması önerilmektedir (7)(8)(9)(10).…”

“…Lopez Jurado ve ark. 'nın yaptığı bir çalışmada ilk sitolojik incelemesi yetersiz ya da malignite açısından kuşkulu olarak değerlendirilen 8 hastaya yapılan ikinci sitolojik incelemede bu hastaların 5'inde malignite tanısı doğrulanmıştır (1). Bizim çalışmamızda ise yetersiz materyal olan iki vakada tekrarlanan sitoloji sonucu yine malignite negatif olarak bulundu.…”