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

Okonkwo, Adaora; Frias, Denise V.S. De; Gunn, Raymond; Diaz, Leslie K.; Schindler, Susanne; Lal, Aseem; Nayar, Ritu

doi:10.1159/000326547

Cited by 28 publications

(42 citation statements)

References 17 publications

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“…Cases were reclassified on review, using previously defined cytomorphologic criteria, as benign (13), reactive (3), atypical (2) or malignant (3) according to major and minor cytologic criteria. 1 The majority of cases with benign cytology (9 of 13) had clinically and cytologically benign followup. Two of 13 had bile duct stones, and 1 patient had ascending cholangitis.…”

Section: Resultsmentioning

confidence: 98%

Role of Biliary Brush Cytology in Primary Sclerosing Cholangitis

et al. 2004

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Section: Resultsmentioning

confidence: 98%

Role of Biliary Brush Cytology in Primary Sclerosing Cholangitis

et al. 2004

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“…3 Strict adherence to cytomorphologic criteria for malignancy, in particular nuclear membrane irregularities and abnormal chromatin pattern, has been shown to decrease 'atypical' diagnoses in biliary brushings. 8 The expansion of liquid-based preparation methods for thin-layer nongynecologic cytology occurred, for the most part, after these diagnostic criteria for malignancy were described. Recent work has found that the addition of ThinPrep 1 to direct smear for evaluation of duct brushings showed superior sensitivity and accuracy compared with other preparation methods such as direct smear only or direct smear plus cytospin.…”

Section: On Thinprepmentioning

confidence: 99%

Use of the ThinPrep® method in bile duct brushings: Analysis of morphologic parameters associated with malignancy and determination of interobserver reliability

Waugh

Guy

Maygarden

et al. 2008

Diagnostic Cytopathology

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Recent work suggests the ThinPrep method can improve diagnostic sensitivity and accuracy in bile duct brushings. However, the proportion of atypical and suspicious diagnoses remains high. The aim of this study was to identify the most useful morphologic features in ThinPrep bile duct cytology and evaluate interobserver reliability. We evaluated 100 bile duct brushings prepared by ThinPrep, all with either histology or long term clinical follow-up (55 malignant, 45 benign). Morphologic features were evaluated by four experienced cytopathologists blind to clinical information and follow-up diagnoses. These features included cellularity, blood or diathesis, mitoses, inflammation, three-dimensional groups, discohesive atypical cells, macronucleoli, well-defined cytoplasmic borders, and nuclear features of malignancy (nuclear membrance irregularity, chromatin clumping). The data were analyzed by intraclass correlation (ICC) and stepwise multiple logistic regression. Reviewers showed unanimous agreement in 29% of cases, one degree of disagreement in 58% of cases, and full disagreement in 13% of cases. Of benign cases, 38% were thought to be diagnostic of malignancy by at least one of the four reviewers. Sensitivity for the morphologic parameters varied from 18 to 67%; the highest sensitivity was for discohesive atypical cells, well-defined cytoplasmic borders, nuclear features of malignancy, and cellularity (67, 62, 51 and 46%, respectively). Specificity of parameters varied from 16 to 100%; the highest specificity was for mitoses, three-dimensional groups, nuclear features of malignancy, and macronucleoli (100, 98, 93, and 93%, respectively). Interobserver reliability (ICC) was very good for specimen cellularity (0.72) and nuclear features of malignancy (0.60). In logistic regression analysis, only nuclear features of malignancy and increasing patient age separated benign from malignant. On ThinPrep bile duct brushings, nuclear features of malignancy are most useful in distinguishing benign from malignant, and interobserver reliability for this parameter is very good. Discohesive atypical cells show moderate sensitivity and specificity, while three dimensional clusters and macronucleoli are specific but not sensitive for malignancy, and are not significant in multivariate logistic regression models. The relatively high proportion of benign cases thought to be diagnostic of malignancy by at least one reviewer argues for a consensus approach to this diagnosis.

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“…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.…”

Section: 13mentioning

confidence: 99%