Bile Duct Brushing Cytology: Statistical Analysis of Proposed Diagnostic Criteria

Abstract

A b s t r a c t

Reporting the Presence of Signi.cant Epithelial Atypia in Pancreaticobiliary Brush Cytology Specimens Lacking Evidence of Obvious Carcinoma

“…16 We think that far from being a "wastebasket" for difficult cytologic diagnoses, inconclusive diagnostic categories (atypical, suspicious) with the addition of qualifiers alerts the clinician to the possibility that a more ominous lesion might be present in the pancreatic or bile ducts of patients exhibiting SALOC on EBC smears. Other large case series on bile duct brush cytology have reported 95% specificity and 36% sensitivity 17 and sensitivities of 78% and 38% for bile duct and pancreatic carcinoma, 7 respectively. Other studies on much smaller patient populations reported sensitivities and specificities of 71% and 100% 18 and 82% and 87%, 19 respectively.…”

The role of brush cytology in diagnosing lesions of biliary tract

“…In general, the accuracy of positive diagnosis is 34-83% with specificity upto 98%. 14,17,23 The site of stenosis did not influence the sensitivity and technical success. [24][25][26] Present study showed sensitivity of 60% and various authors showed the sensitivity (33% to 83%) of their studies (Table 6).…”

“…7,14,15 Because of small masses and difficulty in localization, the sensitivity of fine-needle aspiration cytology is low, and certain malignant stenosis may not be clearly demonstrated by this invasive method. 16 Most benign strictures are managed conservatively with ductal dilatation and stenting.…”

“…Although some sophisticated techniques for the preoperative diagnosis of obstructive jaundice are available, the difficult manipulation and low sensitivity have limited them being used widely in clinical practice. 14,19 Biliary tract brush cytology, however, has been becoming the method of choice in the evaluation of patients with biliary tract strictures. Cytologically positive smears for malignant cells showed nuclear molding, chromatin clumping, high nuclear/ cytoplasmic (N/C) ratio and less frequently, disordered cell clusters, nucleoli, mitosis and cytoplasmic, vacuoles ( Figure 5-8).…”

Reclassification of “Atypical” Diagnoses in Endoscopic Retrograde Cholangiopancreaticography–Guided Biliary Brushings

“…4,6,[12][13][14][15][16] In some studies, a combination of these procedures was utilized. 1,8,17,18 During cytologic evaluation of biliary brushings, 3 categories of diagnosis are rendered: benign, atypical and malignant. While malignant diagnoses are very helpful, it is not always clear how an "atypical" diagnosis is arrived at by the cytopathologist.…”