Diagnostic Value of Brush Cytology in the Diagnosis of Duodenal, Biliary, and Ampullary Neoplasms

Abstract

Endoscopy is a valuable tool in the diagnosis and management of duodenal lesions and biliary strictures. We assessed the value of cytology in the evaluation of these lesions and analyzed the causes of discrepancy among clinical, histologic, and cytologic parameters. The study included 118 patients with duodenal ulcers, ampullary neoplasms, or biliary strictures who were examined between 1975 and 1995; 120 cytologic examinations were performed. The specimens included brushings of the duodenum (DB, n = 50), ampulla (AB, n = 32), and biliary ducts (BB, n = 38). Endoscopic biopsies performed concurrently included the duodenum (n = 37), the ampulla (n = 22), and the biliary ducts (n = 23). Comparison of cytologic and histologic results showed the following sensitivity and specificity: DB, 40% and 97%, respectively; AB, 100% each; BB, 75% and 93%, respectively. The DB, AB, and BB revealed malignant neoplasms in 2 of 5, 7 of 7, and 6Inflammatory, infectious, and neoplastic conditions affecting the biliary tract and duodenum, including the ampullary region, are amenable to evaluation by exfoliative and brush cytology. Endoscopic evaluation of the disease process is a critical approach to assessing the cause and complements the available radiologic techniques, particularly in cases of biliarytree disorders. In instances of obstructive jaundice, ultrasonography and computed tomography scan can establish the level of biliary stricture and may suggest a malignant nature, but the presence or of 8 cases, respectively. Twenty-three duodenal neoplasms were diagnosed by either modality and included 11 adenocarcinomas, 9 villous tumors, 2 metastatic renal cell carcinomas, and 1 large cell non-Hodgkin's lymphoma. Endoscopic brush cytology is an effective means of diagnosing ampullary neoplasms, and it complements tissue biopsy in cases of bile duct stricture. Location, predominance of tumor-induced stroma, an extramucosal growth pattern, sampling error, and interpretative experience influence the diagnostic evaluation. Cytologic diagnosis of an adenoma does not exclude an underlying malignant neoplasm in ampullary tumors. In some instances, it may be difficult to distinguish between villous tumors with severe dysplasia and adenocarcinomas by cytology alone.

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

“…These features were adopted based on our personal experience and review of prior publications. 1,8,12,13,17 Cases were classified as malignant if both major and the 2 most useful minor criteria, altered polarity and high N/C ratio, were present, while atypical cases represented cases that showed rare cells fulfilling major criteria (quantitatively short of a diagnosis of malignancy) and had at least 2 minor criteria. Statistical analysis was performed for each cytologic parameter using an unpaired Student t test.…”

“…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.…”

“…4,19 Some authors prefer to designate these diagnoses as low and high grade dysplasia 1,10 using cytomorphologic criteria that have tremendous overlap with malignancy and repair. 1,12 On follow-up, most of these patients have documented evidence of infiltrating carcinoma, 1,10,12 indicating that to be more clinically useful, the atypical category of reporting biliary cytology should be minimized. Even though a diagnosis of dysplasia makes clinicians aware that an overt malignancy may exist, 1,10,15 it does not provide definitive evidence of carcinoma, suggesting the need for further evaluation of these patients.…”

Comparative molecular analysis of loss of heterozygosity in adenocarcinoma in bile duct brushings and corresponding surgical pathology specimens

“…The cytopathologic criteria for malignancy included nuclear enlargement, pleomorphism (minimum of threefold variation in nuclear size), an elevated nuclear:cytoplasmic (N:C) ratio, nuclear membrane irregularity, and coarse chromatin. 3 Cases diagnosed as "suspicious" fulfilled most but not all criteria for malignancy or were noted in association with a confounding factor, such as infection. The study was reviewed and approved by the University of Pittsburgh Medical Center Institutional Review Board.…”

k‐ras Point Mutations in the Supernatants of Pancreatic Juice and Bile Are Reliable for Diagnosis of Pancreas and Biliary Tract Carcinomas Complementary to Cytologic Examination

“…[1][2][3][4][5][6] DNA analysis with polymerase chain reaction (PCR) amplification has been introduced for detection of K-ras gene mutations in pancreatic juice [4][5][6][7][8][9][10][11] and feces, 12,13) and for microsatellite and p53 suppressor gene changes in urine and sputum. [14][15][16] However, these analyses have been performed basically with cells scraped from slides or in sediment.…”