The impact of brush cytology from endoscopic retrograde cholangiopancreatography (ERCP) on patient management at a UK teaching hospital

Sethi, Rajiv K.; Singh, Kaushiki; Warner, Ben; Mahadeva, Ula; Wilkinson, Mark

doi:10.1136/flgastro-2015-100643

Cited by 9 publications

(7 citation statements)

References 18 publications

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“…134 Once depreciated, the technique is simple and it allows patients to be spared invasive procedures. 135 Finally, bile may be collected through a nasobiliary or percutaneous drain and then prepared for cytopathological examination by centrifugation. This technique is cumbersome but it can provide acceptable sensitivity if properly applied on serial samples.…”

Section: Screening (Asymptomatic Subjects)mentioning

confidence: 99%

Challenging biliary strictures: pathophysiological features, differential diagnosis, diagnostic algorithms, and new clinically relevant biomarkers - part 1

Dumonceau

Delhaye

Charette

et al. 2020

Therap Adv Gastroenterol

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It is frequently challenging to make the correct diagnosis in patients with biliary strictures. This is particularly important as errors may have disastrous consequences. Benign-appearing strictures treated with stents may later be revealed to be malignant and unnecessary surgery for benign strictures carries a high morbidity rate. In the first part of the review, the essential information that clinicians need to know about diseases responsible for biliary strictures is presented, with a focus on the most recent data. Then, the characteristics and pitfalls of the methods used to make the diagnosis are summarized. These include serum biomarkers, imaging studies, and endoscopic modalities. As tissue diagnosis is the only 100% specific tool, it is described in detail, including techniques for tissue acquisition and their yields, how to prepare samples, and what to expect from the pathologist. Tricks to increase diagnostic yields are described. Clues are then presented for the differential diagnosis between primary and secondary sclerosing cholangitis, IgG4-related sclerosing cholangitis, cholangiocarcinoma, pancreatic cancer, autoimmune pancreatitis, and less frequent diseases. Finally, algorithms that will help to achieve the correct diagnosis are proposed.

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Section: Screening (Asymptomatic Subjects)mentioning

confidence: 99%

Challenging biliary strictures: pathophysiological features, differential diagnosis, diagnostic algorithms, and new clinically relevant biomarkers - part 1

Dumonceau

Delhaye

Charette

et al. 2020

Therap Adv Gastroenterol

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show abstract

“…However, the diagnostic value of biliary duct cell brushing was challenged recently because of high frequencies of false positive and negative results. 3 – 5 High false negative rates were associated with sampling errors and technical faults, 6 and false positive cytological diagnoses occurred most often in patients with primary sclerosing cholangitis, IgG4-related cholangitis and autoimmune pancreatitis. 4 Moreover, the desmoplastic reaction around the tumor also limits the sensitivity of this technique.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of brush cytology in biliopancreatic strictures: a single-center cohort study

Ding

et al. 2021

J Int Med Res

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Objective False positive and negative results are associated with biliary tract cell brushing cytology during endoscopic retrograde cholangiopancreatography (ERCP). The causes are uncertain. The purpose of this study was to evaluate the accuracy of diagnoses made via cell brushing in our center, and to explore the factors influencing diagnosis. Methods The clinical data of patients who underwent cell brushing at our center from January 2016 to August 2019 were retrospectively analyzed. These included age, gender, stricture location, thickness of the bile duct wall in the narrow segment, maximum diameter of the biliary duct above the stricture, number of cell brush smears, carbohydrate antigen 19-9, and carcinoembryonic antigen. Positive brush cytology results were compared with results of surgical histology or tumor biopsy as well as with the patient’s clinical course. Results Of the 48 patients who underwent cell brushing cytology, 27 (56.3%) had positive results. The sensitivity and specificity of biliary duct cell brushing was 79.4%, and 85.7%, respectively. None of the above-mentioned factors were associated with positive cytology brushing results. Conclusions Cell brushing cytology remains a reliable method for diagnosis of pancreaticobiliary malignancies.

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“…However, the utility of RC is limited, and the sensitivity (SE) of RC is reported to range from 4% to 55% . Thus, malignancy should not be excluded due to negative RC results.…”

Section: Introductionmentioning

confidence: 99%

The value of DNA image cytometry combined with brush routine cytology in diagnosing indeterminate biliary strictures: A large sample size retrospective study

Yang

Sun

Guo

et al. 2019

J of Gastro and Hepatol

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Background and Aim:Brush cytology is widely applied to diagnosis indeterminate biliary stricture but suffer from low sensitivity. Changes in DNA content are a character of malignant cell and can be detected by DNA image cytometry (DNA-ICM). The study aimed to estimate the value of routine cytology (RC), DNA-ICM, and their combination in diagnosing indeterminate biliary strictures. Methods: A total of 362 patients who underwent both RC and DNA-ICM tests were analysed. Their results were retrospectively applied to final diagnoses. Diagnostic values were compared among RC, DNA-ICM, and their combination based on the location of strictures. Results: The DNA-ICM and combination of two methods had higher diagnostic accuracy than RC in all strictures (63.3% vs 42.3%, P < 0.001, 64.36% vs 42.3%, P < 0.001) and in distal strictures (65.36% vs 42.81%, P < 0.001, 66.01% vs 42.81%, P < 0.001). But in proximal strictures, DNA-ICM showed no superior (51.8% vs 42.81%, P = 0.184). Combination of two methods was not fully significant superior to RC in proximal strictures (55.36% vs 39.29%, P = 0.089). After classification of "suspicious for malignancy" as positive for malignancy, the diagnostic accuracy of DNA-ICM was still higher than that of RC in all strictures (63.3% vs 51.9%, P = 0.002) and in distal strictures (65.36% vs 52.29%, P = 0.001). Combination of two methods was no superior to DNA-ICM alone (64.36% vs 63.3%, P = 0.757). The utilization of DNA-ICM was more accurate in distal strictures than in proximal strictures (65.36% vs 51.8%, P = 0.017). Conclusion: DNA-ICM is an objective and effective addition tool with RC, especially in distal strictures. The combination of DNA-ICM and RC showed no superior to DNA-ICM alone but could improve diagnostic accuracy to RC in proximal strictures although not fully significant. ) 0.738 (0.625-0.853) † Suspicious cytology findings were considered indications of malignancy.AUC, area under curve; DNA-ICM, DNA image cytometry; NPV, negative predictive value; PPV, positive predictive value; SE, sensitivity; SP, specificity.

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The impact of brush cytology from endoscopic retrograde cholangiopancreatography (ERCP) on patient management at a UK teaching hospital

Cited by 9 publications

References 18 publications

Challenging biliary strictures: pathophysiological features, differential diagnosis, diagnostic algorithms, and new clinically relevant biomarkers - part 1

Challenging biliary strictures: pathophysiological features, differential diagnosis, diagnostic algorithms, and new clinically relevant biomarkers - part 1

Accuracy of brush cytology in biliopancreatic strictures: a single-center cohort study

The value of DNA image cytometry combined with brush routine cytology in diagnosing indeterminate biliary strictures: A large sample size retrospective study

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