DIAGNOSTIC-VALUE OF BRUSH CYTOLOGY IN THE DIAGNOSIS OF DUODENAL, BILIARY, AND AMPULLARY NEOPLASMS

Endoscopy is a valuable tool in the diagnosis and management of duoden al lesions and biliary strictures. We assessed the value of cytology i n the evaluation of these lesions and analyzed the causes of discrepan cy among clinical, histologic, and cytologic parameters. The study inc luded 118 patients with duodenal ulcers, ampullary neoplasms, or bilia ry strictures who were examined between 1975 and 1995; 120 cytologic e xaminations were performed. The specimens included brushings of the du odenum (DB, n = 50), ampulla (AB, n = 32), and biliary ducts (BB, n = 38). Endoscopic biopsies performed concurrently included the duodenum (n = 37), the ampulla (n = 22), and the biliary ducts (n = 23). Compar ison of cytologic and histologic results showed the following sensitiv ity and specificity: DB, 40% and 97%, respectively; AB, 100% each; BB, 75% and 93%, respectively. The DB, AB, and BE revealed malignant neop lasms in 2 of 5, 7 of 7, and 6 of 8 cases, respectively. Twenty-three duodenal neoplasms were diagnosed by either modality and included 11 a denocarcinomas, 9 villous tumors, 2 metastatic renal cell carcinomas, and 1 large cell non-Hodgkin's lymphoma. Endoscopic brush cytology is an effective means of diagnosing ampullary neoplasms, and it complemen ts tissue biopsy in cases of bile duct stricture. Location, predominan ce of tumor-induced stroma, an extramucosal growth pattern, sampling e rror, and interpretative experience influence the diagnostic evaluatio n. Cytologic diagnosis of an adenoma does not exclude an underlying ma lignant neoplasm in ampullary tumors. In some instances, it may be dif ficult to distinguish between villous tumors with severe dysplasia and adenocarcinomas by cytology alone.