Combined Use of Cytology, IMP3 Immunocytochemistry, and Forceps Biopsy Increases the Diagnostic Yield in the Detection of Pancreatico-Biliary Malignancy.
Jesse Hart, Meena Parab, Daniza Mandich, Richard Cartun, Saverio Ligato. Hartford Hospital, CT
Background: Biliary brushing and EUS/FNA are two common techniques used to obtain material for the cytologic evaluation of biliary stenosis. Due to their low sensitivity in the detection of malignancy, new ancillary techniques such as Spy Glass probe with forceps biopsy during ERCP and immunoperoxidase staining of biliary brushing/aspirated material for insulin-like growth factor messenger RNA binding protein-3 (IMP3) have been used to improve diagnostic sensitivity. In the current study, we compared the individual and combined use of routine cytology, IMP3 staining, and forceps biopsy in the analysis of such specimens.
Design: We retrospectively evaluated 30 patients who underwent ERCP for biliary strictures, in which both cytologic and forceps biopsy material was obtained. Papanicolaou (PAP) staining and immunocytochemical staining for IMP3 was performed on all cytology specimens. Follow up data, including histologic evaluation of primary tissue resection, histologic evaluation of metastatic disease, and radiographic/clinical information, were obtained. Stastical analysis were calculated for the individual and combined methods.
Results: Sixteen of 30 patients (53%) were definitively diagnosed with malignancy by primary or metastatic tissue evaluation and radiographic/clinical information. Routine cytologic diagnoses included 26 cases negative and 4 cases positive for malignancy. Forceps biopsy diagnoses included 23 cases negative and 7 positive for malignancy. IMP3 evaluation yielded 20 negative and 10 positive interpretations. Stastical analysis of individual and combined methods are reported in the table:
|Brush Cytology & Forceps Biopsy/italic||56.3%||100%||100%||66.7%|
|Brush Cytology and IMP3/italic||68.8%||92.9%||91.7%||72.2%|
|Brush Cytology, Forceps Biopsy, and IMP3/italic||81.3%||92.9%||92.9%||81.3%|