Value of exfoliative cytology for investigating bile duct strictures.

Davidson, Brian R; Varsamidakis, Nicholas; Dooley, James; Deery, Alastair R.S.; Dick, Robert; Kurzawinski, Tomasz R.; Hobbs, K. E. F.

doi:10.1136/gut.33.10.1408

Cited by 59 publications

(46 citation statements)

References 14 publications

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“…In general, sensitivity is more important than specificity in serious diseases such as cancer. Bile cytology, in theory, can deliver perfect specificity, as it directly observes cancer cells in the samples, but its reported sensitivity is rather poor to range between 35% and 40% [15,37]. We also obtained 41% sensitivity using bile cytology for our patients.…”

Section: Discussionmentioning

confidence: 66%

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A new NMR-based metabolomics approach for the diagnosis of biliary tract cancer

Yoo

Kang

et al. 2010

Journal of Hepatology

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Section: Discussionmentioning

confidence: 66%

“…ERCP cytology alone gives a low sensitivity of 35% [15], and an additional brushing step was reported to improve the sensitivity [16]. This brush cytology is now the most common tissue sampling technique and it can be performed for most biliary strictures detected by endoscopic cholangiography.…”

Section: Introductionmentioning

confidence: 99%

A new NMR-based metabolomics approach for the diagnosis of biliary tract cancer

Yoo

Kang

et al. 2010

Journal of Hepatology

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“…After identifying the stricture by direct cholangiography using a 23 gauge Chiba needle (William Cook, Letchworth, Herts, UK) a guide wire was inserted into the biliary tree through a Surgimed sheath needle (Meadox, Dunstable, UK) and negotiated through the stricture into the duodenum. With the guide wire in-situ the stricture was brushed through the catheter (PTC-Br) or a biliary stent (10)(11)(12)(13)(14) Fr gauge) was then inserted. Bile was collected at the end of the procedure once the stent was in position (PTC-BL).…”

Section: Perc U Tan Eous Transh Epa Tic Ch Ola Ngiograp H Ymentioning

confidence: 99%

Biliary tract cytology in specimens obtained by direct cholangiographic procedures: A study of 74 cases

et al. 1996

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A retrospective review of bile (BL) and biliary tract brushings (Br) obtained by endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) was undertaken to determine the sensitivity and specificity of cytology in the diagnosis of pancreaticobiliary malignancies. A total of 104 cytologic specimens (PTC‐BL 15, PTC‐Br 13, ERCP‐BL 8, ERCP‐Br 68) received between 1990 and mid‐1994 from 77 patients who had undergone ERCP and/or PTC primarily for biliary stricture were reviewed. Specimens were unsatisfactory/inadequate in 11 (10.6%), benign in 41 (39.4%), suspicious in 25 (24%), and positive for malignant cells in 27 (26%). Follow‐up was available in 74/77 patients; 46 (59.7%) had tissue confirmation while 28 (32.5%) had adequate clinical follow‐up based on chart review. Of those with histologic confirmation, there were 32 malignant and 14 benign cases. The overall sensitivity and specificity of PTC‐ and ERCP‐obtained cytologic specimens were 88.9 and 95.7% respectively. There was only one false positive case (ERCP‐Br). Overall positive predictive value was 96%, negative predictive value 88%, and accuracy 96%. PTC had a significantly lower sensitivity rate (42.8%) and higher rate for unsatisfactory specimens (21%) compared with ERCP‐obtained material (100 and 1.9%). Bile obtained by PTC or ERCP appeared less sensitive in detecting malignancies compared with endoscopic brushing using either technique (BL 50% vs. Br 100%). All three false negative cases were PTC‐BL specimens. Of the 17 suspicious cases, eight were confirmed histologically as malignant, four were clinically consistent with malignancy, and five showed marked inflammatory atypia on biopsy. Positive predictive value and accuracy rate of a “suspicious cytology” diagnosis were 69 and 80.5%, respectively. Inadequate specimen, poor cellular preservation, and cells obscured by bile all interfere with proper cytologic evaluation. Experience is necessary to appreciate subtle malignant changes in well differentiated carcinomas. Communication between the cytopathologist and the clinician is critical in the accurate interpretation and proper management of the patients. Diagn Cytopathol 1996;14:334–348. © 1996 Wiley‐Liss, Inc.

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“…However, due to cell injury and degradation induced by various proteases present in the bile juice, the accuracy of cytology for the diagnosis of BTCa has not been satisfactory. 2,3 In this series, we detected p53 mutations in 50% of bile samples from BTCa patients, but no p53 mutations were detected in the samples from patients with benign biliary diseases. Furthermore, p53 mutations, with high cancer specificity, were detected in 6 of 15 (40%) BTCa patients in whom bile cytologic diagnosis was negative, and 2 of these patients demonstrated p53 mutations alone.…”

Section: Discussionmentioning

confidence: 51%

“…Although some skillful cytologists have reported relatively high positive rates in BTCa, the accuracy of bile cytology for the diagnosis of BTCa has been limited, due to cell injury and degradation induced by various proteases present in bile juice. 2,3 Thus, analyses of cancer-related genes in bile for the specific diagnosis of BTCa have been anticipated. Only a few researchers have tried to analyze p53 or K-ras mutations in bile from patients with biliary malignancy, 4,5 but the usefulness of p53 or K-ras genetic analyses seems to be limited because of insufficient sensitivity or false positivity.…”

Section: Introductionmentioning

confidence: 99%