Sensitivity Of Brush Cytology Research Articles

Brush Cytology Performance for the Assessment of Biliopancreatic Strictures

Introduction: Brush cytology is commonly used during endoscopic retrograde cholangiopancreatography for the diagnostic evaluation of biliopancreatic strictures. However, since the overall sensitivity of brush cytology is poor, the exclusion of malignancy is difficult. Recognition of factors related to the patient, technique or lesion may help improve the diagnostic yield of brush cytology. The objective of this study was to evaluate the diagnostic yield of brush cytology in the assessment of biliopancreatic strictures and identify predictive factors associated with a positive diagnosis of malignancy. Methods: Retrospective study that evaluated all consecutive patients that underwent brush cytology for the investigation of biliopancreatic strictures in a tertiary center, between January 2012 and January 2018. Results: One hundred and sixty-five patients that underwent 182 procedures were included. A diagnosis of malignancy was confirmed in 110 patients (66.7%), of whom 62 had positive brush cytology (sensitivity 53.7%, specificity 98.5%, accuracy 69.8%). On the multivariate analysis, age ≥68 years (OR 4.83, 95% CI 1.04–22.37) and lesions suspicious of metastasis on cross-sectional imaging (OR 8.58, 95% CI 1.70–43.38) were independently associated with a positive result. Subanalysis of the patients presenting with these two factors (n = 26) revealed an increase in the diagnostic yield (sensitivity 80.8%). Conclusion: Age ≥68 years and lesions suspicious of metastasis on cross-sectional imaging are independent factors associated with a positive result. Patient selection taking these factors into account may increase the diagnostic yield of brush cytology.

Efficacy of digital single-operator cholangioscopy and factors affecting its accuracy in the evaluation of indeterminate biliary stricture

Indeterminate biliary stricture remains a significant diagnostic challenge. The current method of ERCP with bile duct brush cytology has substantial room for improvement. We aimed to determine the efficacy of a digital single-operator cholangioscopy (DSOC) in evaluation of indeterminate biliary stricture. An observational cohort study was conducted among the patients who underwent DSOC for the indication of indeterminate biliary stricture at a tertiary academic medical center. The outcomes of interests were the accuracy of DSOC in visual interpretation and bile duct sample and identification of any factor(s) that could influence its effectiveness. One hundred five patients were included. The overall accuracy of DSOC in visual interpretation was 89.5%, whereas the accuracy of bile duct sample was 83.2%. The sensitivities of visual impression and bile duct sample were 89.1% and 69.8% and their specificities were 90% and 97.9%, respectively. The degree of endoscopists' experience with fewer than 25 cases and the severity of hyperbilirubinemia negatively impacted the accuracy of DSOC. Among 55 patients with definitive diagnosis of malignant stricture, the sensitivity of combined intraductal forceps biopsy sampling and brush cytology was 80.6%, whereas the sensitivity of brush cytology alone was 47.1%. DSOC augments ERCP in evaluating indeterminate biliary stricture. The acquisition of intraductal forceps biopsy samples should be a requisite in evaluation of indeterminate biliary stricture with DSOC. Discovery of modifiable factors such as the degree of endoscopists' expertise and the severity of hyperbilirubinemia, which can influence the accuracy of DSOC, warrants further studies on patient preprocedure optimization and an endoscopic training program that will cultivate procedural competency.

Abstract No. 561 Percutaneous endoluminal brush cytology in patients suspected of malignant biliary obstruction: Experience from a tertiary cancer center in India

To evaluate endoluminal brush cytology during percutaneous biliary drainage in patients suspected of malignant biliary obstruction. From January 2010 to December 2016, 106 consecutive patients with obstructive jaundice secondary to suspected malignant biliary obstruction underwent 136 endoluminal brush cytology procedures, during or after percutaneous transhepatic biliary drainage in presence of on-site cytologist. The data was collected retrospectively and analysed. The lesions involved the common bile duct (n-21), common hepatic duct (n-22) and hilum with right or left intrahepatic ducts (n-63). In each patient, upto three (mean-1.3) brush cytology specimens were taken with 8F double lumen brush. Definitive diagnosis in each case was established by the Brush cytology, exploratory laparotomy, biopsy/cytology from any other metastatic site or combination of tumour markers, radiological or clinical suspicion and increase in size or metastasis in follow-up. Statistical analysis was performed using chi-square test and Z-test of significance to compare sensitivity and p-value ≤0.05 was considered statistically significant. 66 out of 106 patients had correct diagnoses of malignancy on brush cytology. 3 diagnoses proved to be true-negative & 37 were false-negative. 9 out of 22 patients (40.1%) had malignancy diagnosed in 2nd attempt and 1 of 3 patients (33.3%) had malignancy diagnosed with 3rd attempt. Diagnostic sensitivity and specificity brush cytology for malignant nature of biliary strictures was 64.1% and 100% respectively with accuracy of 65.1%. The sensitivity of brush cytology was highest in proximal hilar block 67.8% as against 38.5% noted for lower CBD block, this difference was statistically significant (p-value ≤0.034). Anastomotic site recurrence had a sensitivity of 46.1% in diagnosing malignant nature of disease. No complications were related to the procedure. Percutaneous endoluminal brush cytology is relatively accurate procedure that is safe & easy to perform through a transhepatic biliary drainage tract. Sensitivity to diagnose malignant stricture was higher in primary and proximal hilar block as against lower CBD block & anastomotic site strictures.

A prospective randomised study of dense Infinity cytological brush versus regularly used brush in pancreaticobiliary malignancy

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) with a cytological sample is a valuable tool in the diagnosis of the aetiology of biliary stricture. Our aim was to evaluate whether a more dense Infinity® cytological brush is more sensitive in diagnosing malignancy than the regularly used brush. Patients and methods We recruited 60 patients with a biliary stricture suspicious for malignancy for a randomised controlled trial. Patients were randomly assigned to an Infinity® brush group (n = 30) and a regularly used cytology brush group (n = 30). All the patients had verified cancer during follow-up. Results Crossing the brush over the stricture was possible in each case without dilatation of the biliary duct. Brush cytology yield was good or excellent in 86.7% of cases with the Infinity® brush and 96.7% with the regular brush (p = 0.161). The cytological sample showed clear malignancy in three patients (10.0%) in the Infinity® group and in 12 (40.0%) patients of the regular brush group (p = 0.007). The cytological diagnosis was highly suspicious for malignancy or malignant in 14 patients (46.7%) in the Infinity® group and in 23 patients (76.7%) in the regular brush group (p = 0.017). The result was benign in 10 patients (33.3%) in the Infinity® group and in four patients (13.6%) in the regular brush group (p = 0.067). Conclusions With the standardised technique, the sensitivity of brush cytology is fairly good. The dense Infinity® brush does not show any advantage regarding sensitivity compared with the conventional cytology brush.

İndetermine koledok darlıklarında fırça sitolojisinin değeri: Şişli Etfal deneyimi

Giriş ve Amaç: Endoskopik retrograd kolanjiopankreatografi esnasında alınan fırça sitolojisi şüpheli koledok darlıkları tanısında yaygın olarak kullanılmaktadır. Çalışmamızda kliniğimizde şüpheli koledok darlığı olan olgulardan alınan fırça sitolojisi sonuçlarının sensitivite, spesifite, pozitif prediktif değer ve negatif prediktif değerini değerlendirmeyi amaçladık. Gereç-Yöntem: Ocak 2013 ile Nisan 2014 tarihleri arasında endoskopik retrograd kolanjiopankreatografi sırasında malign darlıktan şüphelenilerek fırça sitolojisi yapılan hastaların demografik verileri, endoskopik retrograd kolanjiopankreatografi raporları, patoloji raporları ve varsa endoskopik retrograd kolanjiopankreatografi sonrası ameliyat/görüntüleme eşliğinde biyopsi bulguları ve hastalığın seyri ve hastaların sürvileri retrospektif olarak incelendi. Bulgular: Ocak 2013 ile Nisan 2014 tarihleri arasında 35 hastaya 37 işlem yapılarak fırça sitolojisi alındı. Hastaların ortalama yaşı 63.7±12 yıl idi. Vakaların 19’u kadın, 16’sı erkekti. Sitolojik değerlendirme sonuçlarına göre, 3 olguda adenokanser, 1 olguda ileri dereceli displazi ve 1 olguda düşük dereceli displazi saptandı. Sitolojik incelemelerin 20’si hücresel değerlendirme için materyal yeterli ve malignite negatif (2’si tekrar), 3’ü yetersiz materyal ve 9’u indetermine olarak raporlandı. Fırça sitolojisi malign olan 4 olgunun tanısı diğer yöntemlerle de doğrulandı. Düşük dereceli displazili hastada ek inceleme yoktu. Malignite negatif olan 18 hastanın 13’ünün takip verilerine ulaşıldı. Bu 13 hastanın 10’unda takip incelemeleri ile malignite saptanmazken, 3’ünde malignite saptandı. Ayrıca sitoloji sonucu yeterli olmayan ya da indetermine tespit edilen 12 hastanın 3’ünde çeşitli tetkik ve girişimlerle karsinom tanısı konuldu, 9 hastada malignite yoktu. Doğruluk analizi yapıldığında fırça sitolojisi için sensitivite %57.1, spesifite %100, pozitif prediktif değer %100 ve negatif prediktif değer %76.9 olarak hesaplandı. Sonuç: Malign koledok darlığı şüphesi olan olgularda fırça sitolojisinin pozitif prediktif değeri yüksek olmakla birlikte negatif gelmesi maligniteyi ekarte ettirmemekte; malignite şüphesi kuvvetli olan olgularda incelemenin diğer tetkiklerle desteklenmesi gereklidir.

Brush citology in diagnosing biliary and pancreatic illnesses

Introduction: We examined specificity, sensitivity of brush cytology among malignancy suspect biliary and pancreatic jaundiced patients. Our patient group was heterogeneous, 20 of them were females, 12 of them were males, their age was between 40 and 86.

Evaluation of Brushing Cytology in the Diagnosis of Helicobacter pylori Gastritis

To evaluate clinical utility of rapid urease test (RUT), brash cytology and histology for detecting Helicobacter pylori.Brush cytology materials were obtained from the antrum of the stomach in 109 patients who suffered from dyspepsia and were candidates for endoscopy. RUT and histology with hematoxylin-eosin staining were performed. Infection status was established by observation of typical HP in cytology or biopsy.A total of 78% ofpatients were diagnosed as positivefor HP organisms using brush cytology; 66% had histologic results positive for HP and 59% for RUT. Observation of typical organism by cytology or histology was the gold standard; 3 tests results were compared. Sensitivity of brush cytology (95%) was higher than that of histology (80.5%) and RUT (72%).Gastric brushing cytology provides a sensitive, inexpensive, accurate and easy technique for rapid detection of HP infection. When additional information on severity of mucosal damage or presence of cell atypias is not necessary, histologic examination can be omitted; a cost-effective strategy for assessing HP status might consist of taking antral biopsies, the former for RUT, and performing brush cytology slides, which should be stained and examined only when the RUT result is negative.

Can we substitute brush cytology for biopsy in the evaluation of cervical lesions under the guidance of colposcopy?

In cervical cancer screening, colposcopically directed biopsy is the gold standard method for identifying intraepithelial and occult invasive lesions of the uterine cervix. As biopsy needs special expertise and the procedure is not convenient for the patients, we sought to evaluate colposcopically directed brush cytology as a substitute for biopsy of cervical lesions. We studied a series of 150 women who were referred for colposcopic evaluation. Colposcopically directed brush cytology and biopsy were performed for all patients with abnormal colposcopic findings. A total of 40 samples were excluded due to unsatisfactory report of brush cytology. Of the remaining 110 samples, 34 abnormal pathologies were reported in biopsy evaluations, while only 9 abnormal cytologies were reported in brush cytology specimens. Brush cytology sensitivity and specificity were 26% and 97%, respectively. We conclude that colposcopically directed brush cytology is not a safe substitute for biopsy in the evaluation of cervical lesions.

Can we substitute brush cytology for biopsy in the evaluation of cervical lesions under the guidance of colposcopy?

In cervical cancer screening, colposcopically directed biopsy is the gold standard method for identifying intraepithelial and occult invasive lesions of the uterine cervix. As biopsy needs special expertise and the procedure is not convenient for the patients, we sought to evaluate colposcopically directed brush cytology as a substitute for biopsy of cervical lesions. We studied a series of 150 women who were referred for colposcopic evaluation. Colposcopically directed brush cytology and biopsy were performed for all patients with abnormal colposcopic findings. A total of 40 samples were excluded due to unsatisfactory report of brush cytology. Of the remaining 110 samples, 34 abnormal pathologies were reported in biopsy evaluations, while only 9 abnormal cytologies were reported in brush cytology specimens. Brush cytology sensitivity and specificity were 26% and 97%, respectively. We conclude that colposcopically directed brush cytology is not a safe substitute for biopsy in the evaluation of cervical lesions.

Additional p53 and K-ras Immunohistochemical Stain Can Not Enhance the Outcome of Brush Cytology During ERCP

Background and aims: Brush cytology at obstructed biliary tree during ERCP is the standard method for getting the tissue diagnosis in malignant biliary obstruction. K-ras and p53 mutation are common and early molecular events in biliary and pancreas cancer. We evaluate the outcome of brush cytology and study whether additional p53 and k-ras immunohistochemical (IHC) stain can enhance the outcome of brush cytology. Patients and Method: In 97 patients with biliary obstruction, we evaluate if the presence of 3-D cluster of cells on smeared slide, site of bushing (ampulla and distal CBD, mid CBD, proximal CBD), tightness of biliary obstruction (tight, intermediate, loose), and length of obstruction (=< 2 cm, >2 cm) can influence the result of brush cytology. In addition we did IHC stain for p53 and k-ras with brush cytology slides in 64 patients with biliary obstruction. Results: Among 97 patients with biliary obstruction, 78 obstructions was malignant stricture by final diagnosis after surgery and long-term follow up. For malignant biliary obstruction, the sensitivity and specificity of brush cytology during ERCP at stricture were 89.7% and 98.6% respectively. 3-D cluster was more common in malignant obstruction than benign obstruction {68/86 (79.1%) vs. 9/17 (52.9%), p < 0.05}. There were no differences in the sensitivities of brush cytology according to the level of obstruction in CBD, tightness of obstruction, and the length of obstruction. In 64 patients done additional p53 and k-ras IHC stain, sensitivity of brush cytology plus p53 in malignant obstruction was 96.8%, that of brush cytology plus k-ras was 93.7%, that of brush cytology plus p53 and k-ras was 98.4%. But there was no difference in sensitivity on adding p53 or k-ras IHC stain. Conclusion: The diagnostic accuracy of brush cytology at biliary obstruction during ERCP was very high, and 3D-cluster of cells on slide was more common in malignant obstruction. Additional p53 and k-ras IHC stain can not enhance the outcome of brush cytology.

Brush Cytology of Colorectal Malignancies

To evaluate the specificity and sensitivity of brush cytology and biopsy in colorectal malignancies. The study was performed over 3 years, 1998-2000. Seventy-six patients with any colorectal lesion on colonoscopy were selected, and in all of them brush cytology and biopsy were done at the same time. The cytologic smears and biopsies were reviewed separately. The cytologic smears were categorized as negative, suspicious, suggestive or positive for malignancy. The results of cytology and biopsy were compared based on sensitivity and specificity. The gold standard for positive cases was the tissue specimen after surgery; negative cases were followed for at least 1 year. Cases with 1 year of disease-free survival were considered negative. Among 76 cases, 4 were excluded because of unsatisfactory cytologic smears. Of the remaining 72 cases, 31 were male and 41 female. The age range was 19-80 years. Cytology showed 23 positive and 49 negative cases (1 false positive and 3 false negative). Biopsy showed 24 positive and 48 negative cases (no false positives and 1 false negative). There were 47 negative cases, followed for at least 1 year, and after that we considered them definitively negative for malignancy. Sensitivity of cytology and biopsy was 88% and 96%; specificity was 98% and 100%, respectively. Combined use of brush cytology and biopsy had the highest sensitivity, 100%. Brush cytology of the colon is a safe, fast and reliable method for the diagnosis of colorectal cancer. We recommend performing it in conjunction with biopsy. It is also reasonable to perform a repeat biopsy in patients with negative biopsy and positive cytology for a definitive diagnosis.

Feasibility study for use of brush cytology as a complementary method for diagnosis of rectal cancer.

Brush cytology has previously been described as a feasible method for accurately diagnosing colorectal cancer. This study was designed: 1) to determine the sensitivity and specificity of brush cytology for the diagnosis of rectal cancer; 2) to prospectively assess the extent of interobserver variability with this technique; 3) to prospectively examine the cost impact of the addition of brush cytology as a routine method of confirming the diagnosis of rectal cancer. Three hundred fifty-seven patients who attended a rectal clinica and who were found to have a lesion between January 1990 and March 1996 were assessed. Each patient underwent rigid proctoscopy, followed by brush cytology and tissue biopsy. Results were compared with the final histologic diagnosis in each patient. The brushings from the last 92 consecutive patients in this series were independently examined by four cytologists and a pathologist to determine the rate of interobserver variability. Rectal adenocarcinoma was confirmed from surgically resected specimens in 303 patients. Brush cytology accurately diagnosed 278 of them. Of the remaining 25 patients, two had brushings that were insufficient for diagnosis. There was one false-positive case. Forceps biopsy correctly identified cancer in 260 patients, with no false-positive interpretations. Brush cytology accurately identified 53 of 54 adenomas as being benign, and forceps biopsy correctly identified all as benign. Sensitivity of brush cytology in this series was 92 percent, with a specificity of 92 percent. Interobserver agreement was 84 percent. Actual costs incurred with this method was an additional $17.00 per patient. Brush cytology can accurately diagnose rectal cancer in a high proportion of patients. Interobserver variation is low and compares favorably with other forms of cytologic interpretation. The additional cost remains a concern but can be kept within acceptable proportion.