Endoscopic retrograde brush cytology in patients with primary and secondary malignancies of the pancreas.

Abstract

25 October 1978 because of obvious changes due to pancreatic carcinoma (n = 12) beyond the reach of the brush device, technical difficulties (n = 11), or lack of cytological service or equipment to perform cytology (n = 5).Ductal abnormalities were demonstrated by ERCP in all patients (Fig. 1), and were strongly suggestive of malignancy in 58 cases and uncertain in 11 patients. Specimens for histological examination were obtained during surgery in 45 cases and at necropsy in 24 cases. In 12 patients the malignancy were found to be secondary (Fig. 2, Table 1). The ductal abnormality was demonstrated in the head of the pancreas in 45 cases, in the body in 15 cases, and in the tail in nine cases. Islet cell tumours were found in two out of 57 patients with primary pancreatic lesions; the others were adenocarcinoma.For ERBC a polyvinyl tube with side-viewing openings at the side were constructed as described in a previous paper (Osnes et al., 1975). A modification of this brush device (Fig. 3) with three instead of five side-viewing openings seems to be more suitable for retrograde brushing. For ERBC in patients with a narrow papillary opening a thinner brush, measuring 1-4 mm in diameter, has been constructed.

Immunocytochemical detection of p53 protein as an adjunct in cytologic diagnosis from pancreatic duct brushings in mucin-producing tumors of the pancreas

“…In this study, 5 of 9 cases (56%) with carcinoma were correctly diagnosed by Papanicolaou staining in conjunction with ERPDB. Some previous studies have reported that the overall accuracy using endoscopic aspiration cytology ranges from 19‐92% 10‐12. The current study observations indicated that the range of overall accuracy using conventional cytology was not satisfactory, and may be dependent on the interpretation of each pathologist.…”

“…Recently, cytologic confirmation using radiographic findings has been required to distinguish benign from malignant MPT in cases of MPT of the pancreas. The accuracy of conventional cytologic examination of pancreatic duct brushing samples or pancreatic juice collected during endoscopic retrograde pancreatography (ERP) is not satisfactory 10‐12…”

Prospective Randomized Controlled Study Comparing Cell Block Method and Conventional Smear Method for Pancreatic Juice Cytology

“…The sensitivities of the CB method (50%) and smear cytology (39%) for malignant diseases in the present study are unsatisfactory but seem to be quite reasonable. The reported sensitivities of pancreatic juice cytology for pancreatic cancer even with administration of secretin were not satisfactory either, from 30% to 79% 8,13–20 . The sensitivity of pancreatic juice cytology by direct suction without giving secretin has been reported to be only 11.1% 17…”

“…Although brush cytology was expected to be an ideal method for obtaining cytological specimens from pancreatic duct strictures, its diagnostic sensitivities for pancreatic cancer have been reported to be 30% to 85% 8,16,24–31 …”

Current Concept of Endoscopic Ultrasound-Guided Fine Needle Aspiration for Pancreatic Cancer

“…There are several tissue sampling methods for pancreatic lesions, such as (1) a core or wedge biopsy [1], (2) fine needle aspiration (FNA) [2], and (3) collection of pancreatic juice by direct suction, washing, or brushing during endoscopic retrograde cholangiopancreatography (ERCP) [1,3,4]. Among these sampling methods, FNA of the pancreas under US, CT, or EUS guidance has become established as the most reliable and safe procedure.…”