Pancreatic and bile duct brushing cytology in 1000 cases

Abstract

BACKGROUND Duct brushing cytology is an important tool in evaluation of the extrahepatic biliary tract and large pancreatic ducts. The emergence of neoadjuvant therapies underscores the importance of accurate preoperative diagnosis by noninvasive means. Liquid‐based preparation methods, such as ThinPrep, have become popular for nongynecologic cytology specimens. METHODS Findings from bile and pancreatic duct brushings were reviewed over the 10‐year period of 1994‐2003. Cytologic material, imaging reports, and clinical data were reviewed and pathologic and clinical follow‐up data were obtained. The slides were prepared by direct smear only (18.8%), direct smear plus cytospin (14.4%), or direct smear plus ThinPrep (66.8%). RESULTS A total of 1118 specimens were identified (1008 bile duct, 110 pancreatic duct) from 864 patients. The cytologic findings were: 53.5% negative, 16.5% malignant, 18.2% suspicious for malignancy, 11% atypical/inconclusive, 0.8% inadequate. Follow‐up in the form of either histology or at least 6 months clinical observation was available for 82.2% of cases (n = 971). Overall operating characteristics were: 52.6% sensitivity, 99.4% specificity, 98.9% positive predictive value, 67.1% negative predictive value, and 75.7% accuracy. Diagnostic agreement between cytology and follow‐up was the main variable analyzed. Agreement was significantly affected by characteristics of the sampled lesion, with ductal narrowing having the lowest rate of malignancy. In addition, the ThinPrep method showed superior sensitivity and accuracy compared with other preparation methods (P = .02). Nonsignificant associations were noted for patient age and gender, site of lesion, and the presence of either stones or prior stent. CONCLUSION In a large dataset from a single institution, brushing cytology showed modest sensitivity and high specificity. Diagnostic agreement was considerably better for benign cases. The combination of direct smear and the ThinPrep method showed superior sensitivity and accuracy. Cancer (Cancer Cytopathol) 2006. © 2006 American Cancer Society.

Screening for Pancreatic Cancer

“…However, these results have not yielded a high enough sensitivity to be used over serum biomarkers to diagnose pancreatic cancer. 95 Therefore, unless highly specific and sensitive biomarkers are discovered in pancreatic juice, it is currently less useful than serum biomarkers to diagnose pancreatic neoplasms.…”

Biomarkers of Pancreatic Cancer

“…Recent development of the endoscopic pancreatic juice cytology, endoscopic brushing cytology or biopsy from the stenotic duct provided histological evidence for pancreatic cancer, but sensitivity was not satisfactory [3]. Based on these circumstances, novel molecular markers which can improve the sensitivity of cytology and biopsy were extensively studied.…”

Pancreatic Cancer Screening: Attempts and Possibilities

“…Some biomarkers of cells obtained from pancreatic ductal brushing and cytology have been identified. However, they offered little screening sensitivity over serum biomarkers to diagnose pancreatic cancer [34]. The role of positron emission tomography scanning (PET) is still unclear in pancreatic cancer.…”