Browse > Article

Utility of Bile Duct Brush Cytology in Pancreaticobiliary Diseases - Prospective Comparative Study of Conventional Smear and $MonoPrep2^{TM}$ Liquid Based Cytology -  

Lee, Dong-Wha (Department of Pathology, Soonchunhyang University Hospital)
Kim, Mee-Sun (Department of Pathology, Soonchunhyang University Hospital)
Cho, Young-Deok (Department of Internal Medicine, Soonchunhyang University Hospital)
Cheon, Young-Koog (Department of Internal Medicine, Soonchunhyang University Hospital)
Choi, Min-Sung (Department of Pathology, Soonchunhyang University Hospital)
Kim, Dong-Won (Department of Pathology, Soonchunhyang University Hospital)
Jin, So-Young (Department of Pathology, Soonchunhyang University Hospital)
Publication Information
The Korean Journal of Cytopathology / v.17, no.1, 2006 , pp. 38-45 More about this Journal
Abstract
Bile duct brush cytology has been employed as a diagnostic tool for the evaluation of pancreatic and biliary tract strictures. The specificity of this method is high however, its sensitivity is quite low. A recent study employing liquid based cytology (LBC) reported results comparable to those achieved via conventional cytology. Therefore, we have attempted to prospectively evaluate the diagnostic utility of bile duct brush cytology in pancreaticobiliary diseases. A total of 46 cases with bile duct stricture were enrolled including 11 cases of benign stricture, 29 cases of bile duct carcinoma, 3 cases of gallbladder cancer, and 3 cases of pancreatic cancer. Both conventional smear and LBC using $MonoPrep2^{TM}$ system were conducted in each case. The cytological diagnosis of each case was classed into the following categories; benign, suspicious for malignancy, and malignancy. The diagnostic accuracy of both cytologic methods was investigated. LBC evidenced a high rate of material insufficiency (13/46), which was attributed to low cellularity. The kappa index of both cytological methods was 0.508. Cytological and tissue diagnoses were correlated in 25 cases conducted from biopsy or operation. The sensitivity, specificity, positive predictive value, and negative predictive value were 41.2% (7/17), 100% (8/8), 100% (7/7), and 44.4% (10/18) in conventional smear; 58.8% (10/17), 87.5% (7/8), 90.9% (10/11), and 50.0% (7/14) in LBC; and 94.1% (16/17), 87.5% (7/8), 94.1% (16/17), and 87.5% (7/8) in any one of both cytological methods, respectively. Based on these results, the sensitivity of LBC was found to be superior to that of conventional smear and we were able to obtain higher positive predictive value upto 94.1% by simultaneously conducting both cytologic methods.
Keywords
Bile duct; Brush cytology; Liquid based cytology; Kappa index;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Sturm PD, Rauws EA, Hruban RH, et al. Clinical value of K-ras codon 12 analysis and endobiliary brush cytology for the diagnosis of malignant extrahepatic bile duct stenosis. Clin Cancer Res 1999;5:629-35
2 Rumalla A, Baron TH, Leontovich O, et al. Improved diagnostic yield of endoscopic biliary brush cytology by digital image analysis. Mayo Clin Proc 2001;76:29-33
3 Koh JS, Ha CW, Myong NH, Cho KJ, Jang JJ. Analytic study of 362 bile cytologic materials. Korean J Cytopathol 1991;2:73-8   과학기술학회마을
4 Govil H, Reddy V, Kluskens L, et al. Brush cytology of the biliary tract : retrospective study of 278 cases with histopathologic correlation. Diagn Cytopathol 2002;26:273-7   DOI   ScienceOn
5 Park BH, Dong SH, Lee BW, et al. Usefulness of endoscopic brush cytology from malignant biliary obstruction. Korean J Gastrointest Endosc 2001;23:159-63
6 Duggan MA, Brasher P, Medlicott SA. ERCP-directed brush cytology prepared by the Thinprep method : test performance and morphology of 149 cases. Cytopathology 2004;15:80-6   DOI   ScienceOn
7 Bardales RH, Stanley MW, Simpson DD, et al. Diagnostic value of brush cytology in the diagnosis of duodenal, biliary, and ampullary neoplasms. Am J Clin Pathol 1998;109:540-8   DOI
8 Cohen MB, Wittchow RJ, Johlin FC, Bottles K, Raab SS. Brush cytology of the extrahepatic biliary tract: comparison of cytologic features of adenocarcinoma and benign biliary strictures. Mod Pathol 1995;8:498-502
9 Stewart CJR, Mills PR, Carter R, et al. Brush cytology in the assessment of pancreatico-biliary strictures: a review of 406 cases. J Clin Pathol 2001;54:449-55   DOI
10 Park IA, Ham EK. Cytopathologic diagnosis of bile obtained by percutaneous biliary drainage. Korean J Cytopathol 1992;3:1-11   DOI   ScienceOn
11 van Laethem JL, Bourgeois V, Parma J, et al, Relative contribution of Ki-ras gene analysis and brush cytology during ERCP for the diagnosis of biliary and pancreatic diseases. Gastrointest Endosc 1998;47:479-85   DOI   ScienceOn
12 Stewart CJ, Burke GM. Value of p53 immunostaining in pancreatico-biliary brush cytology specimens. Diagn Cytopathol 2000;23:308-13   DOI   ScienceOn
13 Logrono R, Kurtycz DF, Molina CP, Trivedi VA, Wong JY, Block KP. Analysis of false-negative diagnoses on endoscopic brush cytology of biliary and pancreatic duct strictures : The experience at 2 University Hospitals. Arch Pathol Lab Med 2000;124:387-92
14 Wight CO, Zaitoun AM, Boulton-Jones JR, Dunkley C, Beckingham IJ, Ryder SD. Improving diagnostic yield of biliary brushings cytology for pancreatic cancer and cholangiocarcinoma. Cytopathology 2004;15:87-92   DOI   ScienceOn
15 Siddiqui MT, Gokaslan ST, Saboorian MH, Catrick K, Ashfaq R. Comparison of ThinPrep and conventional smears in detecting carcinoma in bile duct brushings. Cancer (Cancer Cytopathol) 2003;99:205-10   DOI   ScienceOn
16 Selvaggi SM. Biliary brushing cytology. Cytopathology 2004;15:74-9   DOI   ScienceOn
17 Tascilar M, Sturm PD, Caspers E, et al. Diagnostic p53 immunostaining of endobiliary brush cytology: preoperative cytology compared with the surgical sepcimen. Cancer 1999;87:306-11   DOI
18 Layfield LJ, Wax TD, Lee JG, Cotton PB. Accuracy and morphologic aspects of pancreatic and biliary duct brushings. Acta Cytol 1995;39:11-8
19 Wang HH, Sovic S, Trawinski G, et al. ThinPrep processing of endoscopic brushing specimens. Am J Clin Pathol 1996;106;163-7   DOI
20 Kurzawinski T, Deery A, Dooley J, Dick R, Hobbs K, Davidson B. A prospective controlled study comparing brush and bile exfoliative cytology for diagnosing bile duct strictures. Gut 1992;33:1675-7   DOI   ScienceOn
21 Glasbrenner B, Ardan M, Bowck W, Preclik G, Moller P, Adler G. Prospective evaluation of brush cytology of biliary strictures during endoscopic retrograde cholangiopancreatography. Endoscopy 1999;31:712-7   DOI   ScienceOn
22 Park SH, Roe IH, Lee MI, et al. Brush cytology and K-ras mutation analysis of the bile for the diagnosis of malignant and benign biliary stricture diseases. Korean J Gastroenterol 2000;35:219-25