The Diagnostic Value of New Preparatory Procedures for Bile Duct Smear Cytology
T Wakasa, K Wakasa, K Inayama, M Shintaku, M Ohsawa, Y Okabe, Y Ohsaki. Osaka Red Cross Hospital, Osaka, Japan; Osaka City University Graduate School of Medicine, Osaka, Japan
Background: The usefulness of brush cytology, routinely performed during endoscopic retrograde cholangiopancreatography (ERCP) to assess biliary stricture, is limited by relatively low sensitivity (18-57%). We assessed two novel cell-yield procedures and evaluate their utility.
Design: Between October 2008 to August 2009, patients found to have a biliary stricture suspicious for neoplasia on ERCP have undergone brush sampling for cytology with a standard single use brush (Cytology brush, Microvasive, Boston Scientific). The cytology specimen is obtained as follows: 1) After brushing, the cytology specimen is immediately transferred to glass slides by smearing the cellular material from the brush directly on two slides.(conventional smear) 2) Following the smearing, the cytologist suspended the cut off head of the brush from a wire, and then directly centrifuged the brush in tissue-culture medium (1 min, 3000 rpm). After removing the brush, the medium was centrifuged again, and the cell pellet smeared onto 2 glass slides. (the brush washing specimen) 3) The remaining sheath and wire were also transferred to the cytological laboratory. The cytologist cut the sheath into every 5-inch segments, and put all of the pieces into the centrifuge tube, and then centrifuged (1 min, 3000 rpm). Thereafter, the contents in the sheath were collected, and were submitted for cytospin preparation. (the contents of the sheath tube) All samples were fixed in 95% ethanol, and stained with Papanicolaou method. Cytologic categories employed were: benign, malignant, suspected malignancy, and inadequate. To evaluate the cellularity of the samples, the number of epithelial cell clusters was evaluated on Papanicolaou stained slide using on image analyzing system (WinROOF, Mitani Co, Tokyo, Japan).
Results: Brushing cytology samples were obtained from 28 patients. Final diagnosis was established by surgery, biopsy, or follow up. The sensitivity, specificity, and accuracy were 60.9%, 62.5%, and 61.3% on conventional smear, 85%, 100%, and 89.3% using the brush washing specimen, and the contents of the sheath tube. The average number of epithelial cell clusters was 5980 on conventional smear, 9901 using the brush washing specimen, and 22592 using the contents of the sheath tube(p>0.01).
Conclusions: Significantly higher cellular and diagnostic yields can be obtained using these novel methods.
Tuesday, March 23, 2010 8:45 AM
Platform Session: Section F, Tuesday Morning