Biliary brush cytology for the diagnosis of malignancy: a single center experience [Citološki razmazi brisa četkicom u dijagnostici malignih promjena bilijarnog stabla: naše iskustvo]

Štoos-Veić, Tajana and Bilić, Branko and Kaić, Gordana and Trutin Ostović, Karmen and Babić, Žarko and Kujundžić, Milan (2010) Biliary brush cytology for the diagnosis of malignancy: a single center experience [Citološki razmazi brisa četkicom u dijagnostici malignih promjena bilijarnog stabla: naše iskustvo]. Collegium Antropologicum, 34 (1). pp. 139-143. ISSN 0350-6134

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Abstract

Differentiation between benign and malignant biliary strictures is critical to the provision of adequate treatment. Brush cytology during the endoscopic retrograde cholangiopancreatography (ERCP) is the most commonly used method for obtaining tissue confirmation of the nature of biliary strictures. It’s specificity is remarkably high but reported sensitivities for the diagnosis of malignancy are low. Aim of our study was to assess sensitivity and specificity of biliary brush cytology in our institution, to find out main causes of false negative diagnoses and to confirm impression that the team approach has impact on sensitivity. Gold standard for diagnosis was definitive surgical histology or adequate clinical follow up for minimum of six month. Direct smears made by cytotechnician at the endoscopy room, and stained according to Papanicolaou and May-Grünwald Giemsa (MGG) were examined for well-recognized features of malignancy on conventional smears as a part of diagnostic routine. Cytologic diagnoses were benign, atypical/reactive, suspicious for malignancy and malignant. Of 143 brushings with available definitive diagnosis 36 (25%) had malignant cytologic diagnosis and 91(63.6%) were classified as benign, 3 were atypical/reactive and 13 suspicious for malignancy with 20 »false-negative« cases. When specimens with atypical and suspicious cytology were excluded from data analysis sensitivity was 64% and specificity was 100% and when suspicious findings were taken into account as true positives sensitivity rose to 71%. We find that biliary brush cytology, although mainly depending on the skill of endoscopist, as well as the experience of the cytologist, is a valuable method for obtaining accurate tissue diagnosis of biliary strictures, thus solving eternal diagnostic dilemma: benign or malignant.

Abstract in Croatian

Preoperativno razlikovanje malignih od benignih suženja bilijarnog stabla usprkos novim dijagnostičkim mogućnostima još uvijek predstavlja izazov, a važnost tkivne dijagnoze je neupitna za izbor odgovarajućeg postupka liječenja. Razmaz brisa četkicom pri endoskopskoj retrogradnoj kolangiopankreatografiji (ERCP) i citološka analiza uzorka je danas uobičajena metoda za dobivanje tkivne dijagnoze. Dosadašnje studije su pokazale da je metoda visoko specifična ali uglavnom slabo osjetljiva zbog velikog broja lažno negativnih citoloških dijagnoza. Cilj ovog rada je bio provjeriti osjetljivost i specifičnost metode u našoj ustanovi, pronaći glavne uzroke lažno negativnih citoloških nalaza te potvrditi utjecaj timskog pristupa na citološku dijagnozu. Zlatni standard za dijagnozu bio je histološki nalaz ili klinički ishod utvrđen praćenjem najmanje šest mjeseci. Svi su razmazi napravljeni metodom direktnog nanošnja materijala sa četkice na staklo odmah po uzimanju uzorka u sobi za endoskopiju uz prisustvo citotehničara. Dio razmaza je odmah fiksiran u etanolu i bojan po Papanicolaou a dio sušen na zraku i bojan metodom po May-Grünwald Giemsi (MGG). Razmazi su rutinski analizirani i ocijenjeni kao benigni, atipični/reaktivni, suspektni i maligni. Od 143 uzorka s poznatim konačnim ishodom njih 36 (25%) je citološki ocijenjeno malignim, 91 (63.6%) uzorak je bio benigan, uz 3 atipična i 13 suspektnih. Konačna maligna dijagnoza je postavljena u 20 od 91 citološki benignog uzorka. Isljučivši uzorke s atipičnim i suspektnim citološkim nalazom iz analize, osjetljivost metode iznosi 64% uz uobičajeno visoku specifičnost od 100%. Stavivši suspektne i pozitivne citološke nalaze u jednu kategoriju kako je uobičajeno, osjetljivost je narasla na 71%. Iako ovisi o vještini endoskopičara i iskustvu citologa možemo slobodno zaključiti da je citološka analiza razmaza brisa četkicom pri ERCP-u vrijedna metoda za dobivanje pouzdane tkivne dijagnoze.

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