Biliary Brushing Cytology: A Proposed Scoring System
M Lavelle, S Bakhiet, A O'Callaghan, D Gibbons. St. Vincent's University Hospital, Dublin, Ireland
Background: Biliary Brushing cytology is a challenging area of histopathology. An objective, standardised scoring system is not established to complement traditional microscopic examination methods. A tabulated scoring system used as an adjunct to routine microscopic evaluation may be a helpful tool in distinguishing benign reactive from malignant specimens, particulary for trainee histopathologists or in low volume practices. The aim of this study was to develop and validate a simple standardised scoring system for liquid based biliary brushing cytology specimens as an adjunct to routine cytologic evaluation.
Design: Fifty consecutive biliary brushing cytology cases were retrieved. Each of eleven cytologic parameters (cohesion, architecture, chromatin quality, nuclear features, pleomorphism, cell borders, mitoses, nucleoli, pyknosis/karyorrhexis, nuclear/cytoplasmic ratio and nuclear preservation) were assessed and scored either 0,1,2 or 0,1 (mitoses) by one author. Each case was given a cumulative score. The minimum score per case was zero and the maximum 21. A score of ≥ 14 was regarded as positive and <14 as negative. Twenty-six cases had surgical follow-up, either biopsy, resection or both.
Results: The standardised scores of the 50 cases were compared with routine cytologic outcome (p=<0.001). Of the 26 surgical cases 19 had a malignant diagnosis. Thirteen of these had ascore of ≥ 14. Seven surgical specimens were negative for malignancy and all had a score of < 14. Significance of the score was assessed by a Fisher's exact test (p=0.005). Specificity = 100% and sensitivity =68.4%. These figures compare very favourably with conventional cytologic analysis.
Conclusions: A complementary standardised simple scoring system for biliary brushing cytology may be helpful as an adjunct to routine cytologic analysis, particularly for the pathologist-in-training or in low volume practices.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 45, Wednesday Afternoon