Brush Cytology Performance for the Assessment of Biliopancreatic Strictures

Abstract

Introduction: Brush cytology is commonly used during endoscopic retrograde cholangiopancreatography for the diagnostic evaluation of biliopancreatic strictures. However, since the overall sensitivity of brush cytology is poor, the exclusion of malignancy is difficult. Recognition of factors related to the patient, technique or lesion may help improve the diagnostic yield of brush cytology. The objective of this study was to evaluate the diagnostic yield of brush cytology in the assessment of biliopancreatic strictures and identify predictive factors associated with a positive diagnosis of malignancy. Methods: Retrospective study that evaluated all consecutive patients that underwent brush cytology for the investigation of biliopancreatic strictures in a tertiary center, between January 2012 and January 2018. Results: One hundred and sixty-five patients that underwent 182 procedures were included. A diagnosis of malignancy was confirmed in 110 patients (66.7%), of whom 62 had positive brush cytology (sensitivity 53.7%, specificity 98.5%, accuracy 69.8%). On the multivariate analysis, age ≥68 years (OR 4.83, 95% CI 1.04–22.37) and lesions suspicious of metastasis on cross-sectional imaging (OR 8.58, 95% CI 1.70–43.38) were independently associated with a positive result. Subanalysis of the patients presenting with these two factors (n = 26) revealed an increase in the diagnostic yield (sensitivity 80.8%). Conclusion: Age ≥68 years and lesions suspicious of metastasis on cross-sectional imaging are independent factors associated with a positive result. Patient selection taking these factors into account may increase the diagnostic yield of brush cytology.

Molecular features of pancreaticobiliary neoplasms: Implications for diagnosis, prognostication, and therapy selection

“…While diagnostic specificity has been high, diagnostic sensitivity has been unacceptably low in many studies. Reported sensitivities for brushings of biliary strictures have ranged from 14% to 79% 36–44 . Many of the more recent or larger studies have reported diagnostic sensitivities between 52.6% and 79% with specificities as high as 99% 40–42 .…”

The role of cytology in the investigation and management of pancreatobiliary lesions with a transition towards a standardised reporting system: An institutional perspective

“…8 More recently, studies have shown that this system can be deployed in a variety of cases to examine biliary pathology and obtain samples that are both suitable for cytological analysis and increase diagnostic yield compared to brush cytology. [9][10][11] A combination of the above studies and meta-analysis data demonstrates the utility of this technique in clinical practice for patients with an indeterminate biliary lesion; it is clear that further studies are required to fully appreciate the value of this technique in clinical practice and the applications for which it is best suited. 12 TA B L E 1 Investigations used in the diagnosis of pancreatobiliary lesions…”

<p>Locally Advanced Pancreatic Ductal Adenocarcinoma: Challenges and Progress</p>

“…83,84 Brushing of the common bile/main pancreatic duct can also be performed during ERCP in patients requiring biliary stenting, although the sensitivity rate does not exceed 40% according to the available data. 83,[86][87][88] Positron Emission Tomography combined with CT (PET/CT) for diagnosis and staging of PDAC is poorly helpful and should be used selectively in addition to MDCT and/or MR. [82][83][84] However, it may be of help in the evaluation of response to NAT or in the follow-up of resected patients. [82][83][84] Patients receiving NAT should be reassessed with MDCT and/or MR despite morphological criteria indicating clinical response are still unclear.…”