Stent Scraping for Histology: An Alternative Method for Obtaining Tissue to Rule out Neoplasia

Abstract

Despite improvement in diagnostic modalities, confirmation of a histologic diagnosis of cancer of the biliary tree and pancreas remains elusive. Attempts to collect positive cytology specimens from vigorous brushings or washings obtained at endoscopy or percutaneously are often unsuccessful. In our unit, we have increased the yield by obtaining tissue scraped from prostheses that have been previously placed in either the bile duct or the pancreatic duct. The stents are first flushed with saline to collect cytology specimens, after which, they are bisected and scraped, and these contents are prepared in a manner similar to that used to prepare biopsy samples. Twelve of 16 scraped samples, 9 bile duct and 3 pancreas, were positive for adenocarcinoma. The cytology specimens were positive in only 4 of the 12. We recommend this method of sampling from material contained within prostheses as an adjunct when previous brushings, washings, or biopsies are negative.

Diagnostic implication of extracellular mucin in pancreatic/biliary brushing and stent cytology

“…However, very few studies have looked at the efficacy of stent cytology in screening for malignancy. [11][12][13][14][15] The studies report high specificity (100%) but generally report low sensitivity (11%-36%) for detecting neoplasms. Although limited in size, our study demonstrates similar findings with a sensitivity of 33% and a specificity of 97%.…”

“…Although the utility of pancreaticobiliary brushing cytology and the diagnostic implication of thick ECM in pancreatic FNA have been previously described in the literature, their implication in brushing and stent cytology has not been studied. However, very few studies have looked at the efficacy of stent cytology in screening for malignancy 11–15 . The studies report high specificity (100%) but generally report low sensitivity (11%–36%) for detecting neoplasms.…”