Retrospective Study
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2014; 6(7): 312-317
Published online Jul 16, 2014. doi: 10.4253/wjge.v6.i7.312
Improved endoscopic retrograde cholangiopancreatography brush increases diagnostic yield of malignant biliary strictures
Frederick K Shieh, Adelina Luong-Player, Harshit S Khara, Haiyan Liu, Fan Lin, Matthew J Shellenberger, Amitpal S Johal, David L Diehl
Frederick K Shieh, Harshit S Khara, Matthew J Shellenberger, Amitpal S Johal, David L Diehl, Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, United States
Adelina Luong-Player, Haiyan Liu, Fan Lin, Department of Pathology and Laboratory Medicine, Geisinger Medical Center, Danville, PA 17822, United States
Author contributions: All authors contributed equally to this work; Shieh FK, Khara HS, Shellenberger MJ, Johal AS and Diehl DL were involved in the clinical management, procedural performance and tissue acquisition of the cases; Luong-Player A, Liu H and Lin F were involved in the cytopathological analysis and diagnostic assessment of the cases.
Correspondence to: David L Diehl, MD, FACP, FASGE, Director of Interventional Endoscopy, Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 N. Academy Avenue, 21-11, Danville, PA 17822, United States. dldiehl@geisinger.edu
Telephone: +1-570-2716856 Fax: +1-570-2716852
Received: March 17, 2014
Revised: April 30, 2014
Accepted: June 10, 2014
Published online: July 16, 2014
Processing time: 121 Days and 0.2 Hours
Abstract

AIM: To determine if a new brush design could improve the diagnostic yield of biliary stricture brushings.

METHODS: Retrospective chart review was performed of all endoscopic retrograde cholangiopancreatography procedures with malignant biliary stricture brushing between January 2008 and October 2012. A standard wire-guided cytology brush was used prior to protocol implementation in July 2011, after which, a new 9 French wire-guided cytology brush (Infinity sampling device, US Endoscopy, Mentor, OH) was used for all cases. All specimens were reviewed by blinded pathologists who determined whether the sample was positive or negative for malignancy. Cellular yield was quantified by describing the number of cell clusters seen.

RESULTS: Thirty-two new brush cases were compared to 46 historical controls. Twenty-five of 32 (78%) cases in the new brush group showed abnormal cellular findings consistent with malignancy as compared to 17 of 46 (37%) in the historical control group (P = 0.0003). There was also a significant increase in the average number of cell clusters of all sizes (21.1 vs 9.9 clusters, P = 0.0007) in the new brush group compared to historical controls.

CONCLUSION: The use of a new brush design for brush cytology of biliary strictures shows increased diagnostic accuracy, likely due to improved cellular yield, as evidenced by an increase in number of cellular clusters obtained.

Keywords: Malignant biliary stricture; Endoscopic retrograde cholangiopancreatography; Brush cytology; Diagnostic yield; Cytopathology

Core tip: The sensitivity of brush cytology for biliary strictures has historically been low (around 30%-60%). Many studies have described efforts to improve cellular yield and diagnostic accuracy with varying success. We describe the development of an improved biliary brush cytology protocol with the use of a new biliary brush design which more than doubled the diagnostic yield of our brush cytology as compared to the historical cases. Cytopathological analysis also showed increased cellular yield, and thus better diagnostic accuracy, with the improved protocol implementation.