The outcomes of "atypical" and "suspicious" bile duct brushings in the identification of pancreaticobiliary tumors: Follow‐up analysis of surgical resection specimens. Issue 11 (27th July 2015)

• Record Type: Journal Article
• Authors: Choi, Won‐Tak; Swanson, Paul E.; Grieco, Verena S.; Wang, Dongliang; Westerhoff, Maria
• Is Part Of: Diagnostic cytopathology. Volume 43:Issue 11(2015:Nov.)
• Page Start: 885
• Page End: 891
• Publication Date: 2015-07-27
• Subjects: Cytodiagnosis -- Periodicals; Pathology, Cellular -- Periodicals; Cytology -- Periodicals; 616.07582
• DOI: 10.1002/dc.23323
• Languages: English
• ISSNs: 8755-1039

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="dc23323-sec-0001" sec-type="section"> <title>Background</title> <p>Bile duct brushing cytology is frequently used to investigate suspected pancreaticobiliary tumors, but it is associated with low diagnostic sensitivity. As recently proposed by the Papanicolaou Society of Cytopathology in its new classification scheme for pancreaticobiliary cytology, the use of "atypical" and "suspicious (for malignancy)" categories may give a better prediction of malignancy and improve patient management.</p> </sec> <sec id="dc23323-sec-0002" sec-type="section"> <title>Methods</title> <p>A series of 65 "atypical" and "suspicious" results initially diagnosed at the University of Washington and Harborview Medical Centers between 2005 and 2012 were analyzed to determine outcomes based on the review of subsequent surgical resection specimens.</p> </sec> <sec id="dc23323-sec-0003" sec-type="section"> <title>Results</title> <p>Seven of 15 (47%) "atypical" cases demonstrated malignant outcomes, whereas 49 of 50 (98%) "suspicious" cases showed documented malignancy within a mean follow‐up of 4 months (<italic>P</italic> < 0.0001 from Pearson's chi‐squared test). The analysis of surgical resection specimens demonstrates that 59% of "atypical" and "suspicious" bile duct brushings with malignant outcomes were pancreatic adenocarcinoma (95% confidence interval (CI): 46–71%), 97% of pancreatic adenocarcinomas caused strictures in the head of the pancreas (95% CI: 86–100%), and that 86% of pancreatic adenocarcinomas were moderate to poorly differentiated (95% CI: 73–99%). Fifty‐three of the 60 (88%) patients in the presence of prior stenting had a histologically confirmed malignancy.</p> </sec> <sec id="dc23323-sec-0004" sec-type="section"> <title>Conclusion</title> <p>The use of "atypical" and "suspicious" categories may allow more accurate surveillance and/or more rapid surgical exploration of pancreaticobiliary tumors. Diagn. Cytopathol. 2015;43:885–891. © 2015 Wiley Periodicals, Inc.</p> </sec> </abstract>