Brush cytology in the assessment of pancreatico-biliary strictures: a review of 406 cases

Aims-To assess the accuracy of brush cytology in patients investigated for pancreatico-biliary strictures. Methods-All pancreatico-biliary brush cytology specimens submitted from two major teaching hospitals over a 6.5 year period were reviewed. Four hundre d and forty eight satisfactory specimens from 406 patients with adequate cl inical and/or pathological follow up data were examined in the study period . Results-Two hundred and forty six patients (60.6%) were shown to have neopl astic strictures. One hundred and forty seven tumours were identified cytol ogically, including 87 of 146 pancreatic carcinomas, 29 of 47 cholangiocarc inomas, one of one bile duct adenoma, four of seven carcinomas of the gallb ladder, eight of 13 ampullary carcinomas, two of three ampullary adenomas, 10 of 16 malignancies of undetermined origin, none of two islet cell tumour s, one of three hepatocellular carcinomas, and five of eight metastatic tum ours. The three adenomas identified on brush cytology could not be distingu ished from adenocarcinoma morphologically. One hundred and sixty patients ( 39.4%) had benign strictures, most often as a result of chronic pancreatiti s and bile duct stones. There were three false positive cytological diagnos es mainly as a result of the misinterpretation of cases with relatively sca nt and/or degenerative atypical epithelial cells. Forty one cases were repo rted as atypical or suspicious of malignancy on brush cytology, of which 29 were ultimately shown to have carcinoma. The overall diagnostic sensitivit y and specificity were 59.8% and 98.1%, respectively. The sensitivity incre ased from 44.3% in the initial third of cases to 70.7% in the final third o f cases examined in the series. Conclusions-Brush cytology, in conjunction with other clinical and radiolog ical investigations, is a useful technique in the assessment of patients wi th suspected pancreatico-biliary neoplasia.