Endobiliary brush biopsy: Intra- and interobserver variation in cytological evaluation of brushings from bile duct strictures

Abstract

The intra- and interobserver agreement in cytological evaluation of endobiliary brushings from bile duct strictures is generally good. The rates of inadequate and suboptimal samples can probably be reduced by modifications of the brush design.

Factors Impacting the Performance Characteristics of Bile Duct Brushings: A Clinico-Cytopathologic Analysis of 253 Patients

“…Our test sensitivity rate is at the lower end of the spectrum of some previously reported in the literature (range, 30%-68%), [14][15][16] but it is higher than rates reported by others (6%-33%), [3][4][5]7,8,22 which could be the result of several factors, some of which we explored in detail.…”

“…Interpretative errors are certainly a known problem with BDBs, as evidenced by studies highlighting low interobserver reproducibility of cytologic categories 17 and even high intraobserver variations in diagnoses. 3 However, our recent study evaluating interreviewer agreement in evaluating BDBs found that both experienced and inexperienced reviewers had similar performance with respect to sensitivity, specificity, and overall accuracy. 19 Additionally, the protocol for obtaining and analyzing BDBs at our institution did not change between 2000 and 2015.…”

“…These variations are presumably related to case definition (identification) as well as the setting in which the studies were performed and the different methods of specimen processing used. 3,17,18 Consequently, the relative impact of different parameters on BDB interpretation by cytopathologists remains unclear and is yet to be fully unraveled.…”

“…1,2 Most studies on bile duct brushings (BDBs) agree that the sensitivity of this modality is fairly low, although the numbers vary substantially from 6% to 64%, [3][4][5][6][7][8][9][10][11][12][13][14][15][16] and the factors implicated in the test's inaccuracies are also significantly different. These variations are presumably related to case definition (identification) as well as the setting in which the studies were performed and the different methods of specimen processing used.…”

“…These variations are presumably related to case definition (identification) as well as the setting in which the studies were performed and the different methods of specimen processing used. 3,17,18 Consequently, the relative impact of different parameters on BDB interpretation by cytopathologists remains unclear and is yet to be fully unraveled.In this study, in order to capture the current state of daily practice, we reviewed our institution's experience with the cytomorphologic analysis of BDBs during the past 15 years to further elucidate the factors that impacted the performance characteristics of the test. Since 11 cytopathologists reviewed the cases during the 15-year period, the potential…”