BRUSH CYTOLOGY FOR PANCREATIC-CARCINOMA - AN ANALYSIS OF FACTORS INFLUENCING RESULTS

Background: Despite recent advances in cytology brush design, yield of endoscopic brush cytology in suspected pancreatic carcinoma remains l ow. Methods: We prospectively evaluated 32 such patients by ERCP to an alyze differences in yield based on anatomic location of the pancreati c stricture, and the role of concurrent biliary stricture brush cytolo gy, in improving the overall yield. Endoscopic brush cytology was perf ormed on all strictures following ERCP. A final diagnosis of pancreati c carcinoma was confirmed in all patients. Results: Twenty-three of th e 32 patients had positive cytology for pancreatic malignancy (71.9%). Eight patients had positive brushings from biliary strictures alone ( 25%) and 15 had positive brushings obtained from pancreatic strictures (46.9%). The yield varied widely depending on the anatomic location o f the stricture; ampullary, genu, and tail regions had low rates of po sitive cytology, in part due to technical factors and brush design (1 of 8, 2 of 6, and 1 of 4, respectively). Strictures of the head and bo dy yielded high rates of positive cytology (7 of 8 and 4 of 6, respect ively). Conclusions: The yield of endopancreatic brush cytology is rel ated to the location of malignancy, with overall yield enhanced by con current brushing of bile duct strictures.