Contribution of examination of cytology brush wash to brush smear in malignant biliary strictures

Öz

Background and Aims: Malignant biliary stricture is known to be a consequence of a heterogeneous group of diseases. Endoscopic retrograde cholangiopancreatography has been widely used in the diagnosis and treatment of biliary diseases for 20 years. If a malignant biliary stricture is suspected during endoscopic retrograde cholangiopancreatography, brush cytology can be obtained for histopathological evaluation. The current study aimed to compare the efficacy of two different methods in the diagnosis of biliary malignancy: 1) directly transferring the cellular material to a glass slide by smearing and 2) dipping the brush into a tube and smearing the supernatant fluid on to a slide after centrifugation. Materials and Methods: Patients with biliary strictures included in the study were required to have a definite final benign or malignant diagnosis by evaluating radiological procedures, tumor markers, histological confirmation, intraoperative signs, and/or clinical progression. Brush cytology specimens obtained during endoscopic retrograde cholangiopancreatography were both directly smeared to three glass slides and then the brushes were cut into a specimen tube, and after centrifugation at 3000 /minute, the fluid was smeared on to the slides. Air-dried May-Grünwald-Giemsa stained smears were prepared for cytological examination. Results: Brush cytology specimens were obtained from 62 patients with biliary stenosis between February 2007 and September 2009 (Boston Scientific, 1.5 cm in length). Thirty-two patients were diagnosed to have malignant stricture. The mean age was 57 years, and 18 of the patients were female. In the total group of patients, 14 were diagnosed as malignant using both methods together (sensitivity 44%). Fourteen (44%) patients had a positive result for malignancy with the conventional method, while only 8 patients had positive results in both methods. There was no case in which the centrifuge fluid was found to be positive while the conventional method was negative. Conclusions: Cytologic examination of the centrifuged brush fluid was shown to have no additive value to the conventional method. Further studies in larger populations are needed.

Anahtar Kelimeler

• Endoscopic retrograde cholangiopancreatography, brush cytology, malignant biliary strictures

Malign biliyer darlıklarda sitoloji fırçasının santrifüj suyunun incelenmesinin yaymaya katkısı

Öz

Giriş ve Amaç: Malign biliyer darlıklar heterojen bir grup hastalık tarafından oluşturulur. Endoskopik retrograd kolanjiopankreatografi bu hastalıkların tanısı ve tedavisinin yönlendirilmesinde son 20 yıldır yaygın olarak kullanılmaktadır. Malign darlık şüphesi olduğunda endoskopik retrograd kolanjiopankreatografi ile fırça sitolojisi yapılarak histopatolojik doku tanısına ulaşılabilmektedir. Malign biliyer darlıklarda fırça sitolojisinin sensitivitesi %50, spesifitesi 75-100 civarındadır. Bu çalışmada sitoloji fırçasının santrifüj suyunun incelenmesinin, sadece lam sürüntüsüyle elde edilen malignite tanısına olan katkısı araştırıldı. Gereç ve Yöntem: Şubat 2007 Eylül 2009 tarihleri arasında biliyer darlığı olan 62 hastadan safra yollarından fırça sitolojisi alındı (Boston Scientific, 1.5 cm). Hastalar görüntüleme yöntemleri, tümör markırları, biyopsi sonuçları, cerrahi bulguları ve klinik seyirlerinden biri veya birkaçı ile malign ve benign olarak ayrıldılar. Hastalardan alınan fırça biyopsileri hasta başında aynı anda 3 adet lama yayıldı ve fırça kesilerek biyopsi şişesine konuldu. Şişe 3000/dk devirde santrifüj edilerek supernatant lama yayıldı. Materyaller May Grünwald Giemsa boyası ile boyandıktan sonra malignite yönünden incelendi. Bulgular: Otuz iki hasta (14 E, 18 K, ort yaş 57) malign darlığa sahipti. Bu hastalarda her iki yöntemle de 14 hastada malignite saptandı (sensitivite %44). Lam sürüntüsü 14 hastada (%44), hem lam sürüntüsü hem de fırça santrifüj suyu 8 hastada pozitifti. Bu seride hiç bir hastada; lam sürüntüsü negatif olduğu halde, fırça santrifüj suyu pozitif bulunmadı. Sonuç: Malign biliyer darlığı olan hastalarda fırça santrifüj suyunun incelenmesi, lam sürüntüsüne katkıda bulunmamaktadır. Bu durumun daha geniş serilerle araştırılması gereklidir.

Anahtar Kelimeler

• Endoskopik retrograd kolanjiopankreatografi, fırça sitolojisi, malign bilier darlık

Kaynakça

1. Perdue DG, Freeman ML, DiSario JA, et al. Plastic versus self-expanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study. J Clin Gastroenterol 2008; 42: 1040-6.
2. Khan SA, Thomas HC, Davidson BR, Taylor-Robinson SD. Cholangiocarcinoma. Lancet 2005; 366: 1303-14.
3. Anderson CD, Pinson CW, Berlin J, Chari RS. Diagnosisn and treatment of cholangiocarcinoma. The Oncologist 2004; 9: 43-57.
4. Khan SA, Davidson BR, Goldin R, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 2002; 51 (Suppl 6): VI1-9.
5. Groen PC, Gores GJ, LaRusso NF, et al . Biliary tract cancers. N Engl J Med 1999; 341: 1368-78.
6. Govil H, Reddy V, Kluskens L, et al. Brush cytology of the biliary tract: Retrospective study of 278 cases with histopathologic correlation Diagn Cytopathol 2002; 26: 273-7.
7. Stewart CJ, Mills PR, Carter R, et al. Brush cytology in the assessment of pancreatico-biliary strictures: a review of 406 cases. J Clin Pathol 2001; 54: 449–55.
8. Kurzawinski TR, Deery A, Dooley JS, et al. A prospective study of biliary cytology in 100 patients with bile duct strictures. Hepatology 1993; 18: 1399-403.

9. Kurzawinski T, Deery A, Dooley J, et al. A prospective controlled study comparing brush and bile exfoliative cytology for diagnosing bile duct strictures. Gut 1992; 33: 1675-7.
10. Singh V, Bhasin S, Nain CK, et al. Brush cytology in malignant biliary obstruction. Indian J Pathol Microbiol 2003; 46: 197-200.
11. Mahmoudi N, Enns R, Amar J, et al. Biliary brush cytology: Factors associated with positive yields on biliary brush cytology. World J Gastroenterol. 2008 Jan 28;14(4):569-73.
12. Kocjan G, Smith AN. Bile duct brushings cytology: potential pitfalls in diagnosis. Diagn Cytopathol 1997; 16: 358-63.
13. Logrono R, Kurtycz DF, Molina CP, et al. Analysis of false-negative diagnoses on endoscopic brush cytology of biliary and pancreatic duct strictures: the experience at 2 university hospitals. Arch Pathol Lab Med 2000; 124: 387-92.