Techniques for cytologic sampling of pancreatic and bile duct lesions

Abstract

The Papanicolaou Society of Cytopathology has developed a set of guidelines for pancreatobiliary cytology including indications for endoscopic ultrasound guided fine-needle aspiration biopsy, techniques of the endoscopic retrograde cholangiopancreatography, terminology and nomenclature of pancreatobiliary disease, ancillary testing, and postbiopsy management. All documents are based on the expertise of the authors, a review of the literature, discussions of the draft document at several national and international meetings over an 18-month period and synthesis of online comments of the draft document on the Papanicolaou Society of Cytopathology website [www.papsociety.org]. This document presents the results of these discussions regarding the use of ancillary testing in the cytological diagnosis of biliary and pancreatic lesions. This document summarizes the current state of the art for techniques in acquiring cytology specimens from the biliary tree as well as solid and cystic lesions of the pancreas.

Pancreatic Sampling by Endoscopic Ultrasound–Guided Fine-Needle Aspiration and Needle Biopsy From the Cytopathology Perspective

“…11,13 In contrast, the smaller 25-gauge EUS-FNA needle was advertised as demonstrating better flexibility and easier manipulation in angulated positions, leading to fewer technical failures, particularly when sampling lesions in the pancreatic head, vascular lesions, or lymph nodes. 7,11,13 There was initial apprehension that this smaller needle might not acquire adequate cellular material compared with the 22-gauge needle, particularly for viscous mucinous cysts and for firm, desmoplastic tumors. 7 Interestingly, several prospective studies specifically assessing this issue did not demonstrate a significant difference in the yield of tissue or diagnostic accuracies between the 22-and 25-gauge needles when used for EUS-FNA sampling of intra-abdominal masses, including solid pancreatic masses.…”

“…7 In addition, EUS-FNA is superior to endoscopic retrograde cholangiopancreatography biopsy or brushing specimens for pancreatic lesions given its higher diagnostic yield, greater sampling capability, and lower complication rate. 7 Some of the inherent factors that influence the ability to acquire a satisfactory and diagnostic EUS-FNA specimens are summarized in Table 1 and include the location of the target lesion, the characteristics of the lesion (eg, cystic, necrotic, or desmoplastic), the experience of the endosonographer and technical difficulty required to obtain a specimen, and the experience of the interpreter of the specimen.…”

“…[4][5][6] More recently, the Papanicolaou Society of Cytopathology created guidelines for pancreatobiliary cytology, which not only address terminology, but also provide information regarding indications for cytologic study, techniques for cytologic sampling, use of ancillary studies, and patient management. 7 These guidelines summarize the most up-to-date information regarding EUS-guided biopsies from the pancreas and bile duct and serve as a guide for both clinicians and pathologists.…”

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

“…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]. This is the best system for collecting tumor cells.…”

The Diagnostic Accuracy of Cytology for the Diagnosis of Hepatobiliary and Pancreatic Cancers

“…Authors attributed this inconsistency to variations in the experience and skills of the operators performing both endoscopy and the cytology sample collection [7]. Methods of acquiring cytology samples include endoscopic forceps biopsy, endoscopic fine needle aspiration (FNA) of the bile duct, endoscopic cholangioscopy, and cytology brushing during endoscopic retrograde cholangiopancreatography [8]. The Sn of endoscopic retrograde cholangiopancreatography-guided cytology brushing ranges from 4 to 50% for detecting HBP tumors [9-11].…”