Grasp or Brush for Biliary Sampling at Endoscopic Retrograde Cholangiography? A Blinded Randomized Controlled Trial

Dumonceau, Jean‐Marc; Gómez, Carlos Macías; Casco, Claudia; Genevay, Muriel; Marcolongo, Mariano; Bongiovanni, Massimo; Morel, Philippe; Majno, Pietro; Hadengue, Antoine

doi:10.1111/j.1572-0241.2007.01543.x

Cited by 39 publications

(29 citation statements)

References 23 publications

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“…However, this observation has not been consistently shown in the literature [1]. Several studies have suggested that the increased exfoliation of tumor cells due to stricture manipulation may increase the diagnostic yield of biliary brush cytology [23-25, 28]. Farrell et al [28] found that stricture dilatation to 10 French and endoscopic needle aspiration significantly increased both the sensitivity and specificity of biliary brushing cytology.…”

Section: Discussionmentioning

confidence: 91%

“…However, such findings have not consistently been demonstrated in the literature, and several authors have reported that stricture dilatation before brush cytology does not increase the sensibility of the technique, although the reasons for that discrepancy remain unknown [1, 34]. Compared with conventional brush cytology, the use of a dedicated basket has been associated with increased sensitivity for cancer detection in a randomized trial [23]. However, in a recent study, biliary sampling with a conventional Dormia basket was found to be comparable to conventional brush cytology in detecting malignant bile duct stricture [24].…”

Section: Discussionmentioning

confidence: 93%

“…However, the diagnostic accuracy of the technique is relatively low, ranging from 5.9 to 65% [1, 10-22]. In a recent review of the literature from 2002 until 2012, including 16 studies and 1,556 patients, biliary brushing cytology was found to be associated with an overall sensitivity of 41.6% and a negative predictive value (NPV) of 58% [23]. To further increase the accuracy of brush cytology, many reports have described different techniques to improve positive yields, including stricture dilatation, repeat brushing, grasp and basket cytology, modified cytology brushes, the cell block method, digital image analysis, and fluorescence in situ hybridization (FISH) [24-31].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Different Methods for Analysis of Biliary Brush Cytology and of Factors Associated with Positive Diagnosis in an Age-Dependent Retrospective Review

Costa

Canena

Mascarenhas-Lemos

et al. 2018

GE Port J Gastroenterol

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Background and Aims: Brush cytology during endoscopic retrograde cholangiopancreatography (ERCP) is the most frequently used strategy for obtaining a tissue sample from an indeterminate biliary stricture. A recent study reported that age is a factor associated with positive yields, but further analysis of how age influences the results was lacking. We aimed to evaluate clinical effectiveness of biliary cytology and prognostic factors for a positive outcome, especially age. Methods: This study was a single-center, retrospective, clinical study of 77 consecutive patients who underwent brush cytology during ERCP to obtain a diagnosis of an indeterminate biliary stricture. We compared 2 routine cytology techniques: A (smear); B (centrifugation of the cytological material collected and the cut-off brush + cell block when sufficient amount of material was available). The data were collected aiming to compare the accuracy of the different techniques used and the prognostic factors affecting the outcome, with a particular focus on age. The yield for brush cytology was compared with the gold standard defined as either definitive histology or the long-term clinical course. Results: The overall accuracy of the 2 used methods was 75.3%. Sensitivity was 52.5%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 66.1%. Although not statistically significant, there was a trend toward accuracy for method B compared with method A (80.4 vs. 65.4%; p = 0.153). Multiple logistic regression analysis showed that younger age was the only independent prognostic factor associated with a positive diagnosis (OR 0.95; 95% CI 0.90–0.99; p = 0.039). Receiver operating characteristic curves for age yielded an area under the curve value of 68.2%. On the basis of the Youden index, 69 years was found to be the optimal cutoff for age. Conclusions: In this series, the accuracy of routine biliary brush cytology was not equal for all methods and ages; in particular, younger patients (below 69 years) tended to have a higher probability of a correct diagnosis.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Outcomes of Different Methods for Analysis of Biliary Brush Cytology and of Factors Associated with Positive Diagnosis in an Age-Dependent Retrospective Review

Costa

Canena

Mascarenhas-Lemos

et al. 2018

GE Port J Gastroenterol

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“…To improve the sensitivity and specificity, many investigators employ various sampling techniques, new devices, the cell block method and molecular methods, such as k-ras point mutation analysis or FISH [7,8,9,10,11,12,13,14,15,16,17,18,19,20]. In some hospitals, to facilitate smear sampling, rapid on-site evaluation is used to prevent air-drying and insufficient sampling [20].…”

Section: Discussionmentioning

confidence: 99%

Brushing Cytology of the Biliary Tract: Bile Juice from the ERCP Sheath Tube Provides Cell-Rich Smear Samples

Wakasa

Inayama²,

Honda³

et al. 2014

Acta Cytologica

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Objectives: To improve the diagnostic accuracy of bile smear cytology, we assessed two cell-yielding procedures. Study Design: One hundred and forty-one patients with biliary stricture underwent endoscopic retrograde cholangiopancreatography (ERCP) and conventional brush sampling. The cytologist cut the brush head off the support wire, centrifuged it directly in tissue culture medium for 1 min at 3,000 rpm, centrifuged the medium again and then smeared the cell pellet onto slides. The remaining sheath tube was then cut into 12-cm segments, which were centrifuged in a centrifuge tube for 1 min at 3,000 rpm, collected and submitted for cytospin preparation. Results: The final histopathological diagnoses based on surgery, biopsy or clinical progression were evaluated for sensitivity, specificity and accuracy. Using conventional smears alone, the sensitivity, specificity and accuracy in patients with biliary stricture were 66.1, 80.7 and 68.8%, respectively. For conventional smears, brush washing and sheath tube contents together, the sensitivity improved to 73.9%, specificity to 100% and accuracy to 78.7%. In the patients with bile duct carcinoma, the sensitivity, specificity and accuracy were 87.3, 100 and 90.7%, respectively. Conclusion: Superior diagnostic accuracy was achieved when conventional smear procedures were combined with the two new procedures.

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“…Some authors have attempted to increase sensitivity and specificity by the use of grasping instruments [3]. A computer-based digital analysis, DNA image cytometry (ICM-DNA), assesses quantitative chromosomal changes, referred to as DNA-ploidy, in the nuclei of atypical cells in reference to normal DNA values determined with unequivocally benign nuclei in the same smear.…”

mentioning

confidence: 99%

Malignant biliary stenosis: conventional cytology versus DNA image cytometry

et al. 2010

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Grasp or Brush for Biliary Sampling at Endoscopic Retrograde Cholangiography? A Blinded Randomized Controlled Trial

Abstract: Biliary sampling at ERC using a dedicated basket provided a significantly higher sensitivity for cancer detection than brushing; presampling stricture dilation significantly increased sensitivity.

Cited by 39 publications

References 23 publications

Outcomes of Different Methods for Analysis of Biliary Brush Cytology and of Factors Associated with Positive Diagnosis in an Age-Dependent Retrospective Review

Outcomes of Different Methods for Analysis of Biliary Brush Cytology and of Factors Associated with Positive Diagnosis in an Age-Dependent Retrospective Review

Brushing Cytology of the Biliary Tract: Bile Juice from the ERCP Sheath Tube Provides Cell-Rich Smear Samples

Malignant biliary stenosis: conventional cytology versus DNA image cytometry

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