Bile duct brushings cytology - improving sensitivity of diagnosis using the ThinPrep® technique: a review of 113 cases

• Published in: Cytopathology (Oxford) Vol. 18; no. 4; pp. 225 - 233
• Main Authors: Sheehan, M.M, Fraser, A, Ravindran, R, McAteer, D
• Format: Journal Article
• Language: English
• Published: Oxford, UK Oxford, UK : Blackwell Publishing Ltd 01.08.2007; Blackwell Publishing Ltd
• Subjects: Adult; Aged; Aged, 80 and over; ampulla; Ampulla of Vater - pathology; bile duct brushings; biliary tree; Biopsy - methods; cell biology; Cell Nucleus - pathology; Cholangiopancreatography, Endoscopic Retrograde; Common Bile Duct Neoplasms - diagnosis; Common Bile Duct Neoplasms - diagnostic imaging; Common Bile Duct Neoplasms - pathology; conventional smears; Cytodiagnosis - methods; cytology; cytopathology; diagnostic techniques; endoscopic retrograde cholangiopancreatography; Female; Histocytological Preparation Techniques - methods; Humans; Male; Middle Aged; pancreas; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Predictive Value of Tests; Reproducibility of Results; sensitivity; Sensitivity and Specificity; ThinPrep® technique
• ISSN: 0956-5507; 1365-2303
• DOI: 10.1111/j.1365-2303.2007.00447.x

Common bile duct (CBD) brushings have been recognized as a technique of moderate sensitivity and high specificity in identifying carcinoma of the ampulla and pancreatico-biliary regions. This study evaluated the increase in sensitivity of this technique using the ThinPrep® technique of specimen preparation when compared with conventional cytology smears. A total of 113 bile duct brushings were included in the study (38 conventional smears and 75 slides prepared using the ThinPrep® technique). All slides were reviewed by one cytologist. Five categories of reporting were used: inadequate, negative, atypia, suspicious and malignant. The inadequate category of reporting disappeared in the ThinPrep® group with improved specimen fixation and preparation and hence reduced artefact. Sensitivity of diagnosis of malignancy increased from 39% in conventional smears to 53% in the ThinPrep® group. Specificity, positive and negative predictive values and accuracy were 100%, 100%, 60% and 68% for conventional smears and were 100%, 100%, 60% and 72%, respectively, for ThinPrep® specimens. ThinPrep® technique was associated with increased sensitivity of diagnosis, in part due to improved specimen fixation and reduced artefact. Cytology of bile duct brushings is an important diagnostic tool for sites from which it can be difficult to obtain a histology biopsy. It may therefore provide the only opportunity for tissue diagnosis of carcinoma from these sites, hence the importance of optimizing sensitivity.