Introduction. Biliary tract brush cytology is increasingly being recognized as a favoured method for evaluating abnormalities of the pancreatic and biliary tract. In order to increase the diagnostic potential of endoscopic brushing of the biliary tract, we devised a novel technique finalized to the complete and ideal cytologic examination of the collected material through an original new brush processing method. Material and methods. 112 consecutive pancreato-biliary brush cytology specimens (67M; 45F) collected at Molinette Hospital, University of Turin, between January 2002 and August 2006 were included in our study. All patients had a definite final benign or malignant diagnosis based either on independent histological or cytological sampling, or on clinical follow-up data (follow-up was median 21 months). Immediately following brushing, the brush is immersed into methanol; then, in order to induce formation of a glue surrounding the brush, in the pathological laboratory it is immersed into egg albumen (a mixture 1:1 of egg albumen and glycerol), and finally returned to methanol. For paraffin embedding, the metal handling is cut away and the remaining brush is introduced into a cassette: paraffin-embedded sections parallel to the long axis of brush are cut until the metal wire is almost reached, then the block is rotated and new sections are obtained from the opposite side. Small fragments of the mucosa, of inflammatory cell aggregates or of carcinomas (stained in Haematoxylin & Eosin and Alcyan blue mucine) were observed in our series, and displayed an optimal fixation allowing a definite diagnosis which proved mandatory for proper therapy in the almost totality of cases. Results. The results obtained on 112 consecutive cases using such technique showed a satisfactory sensibility when compared to final histological diagnosis, this method showed: 87% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 91% negative predictive value (NPV). Moreover when compared this method to the patient clinical diagnosis, after at least 6 months follow-up, it showed: 88% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 96% negative predictive value (NPV). Conclusion. Finally such novel technique proved to be highly sensitive and specific, limiting the un-satisfactory cytological diagnoses to less than 1% and providing a 88% concordance (K value) with the final histology at surgery and a 91% concordance (K value) with patient follow-up.

Histological sectioning of brush bristles allows improved diagnosis of biliary tract

ASIOLI, SOFIA;
2007

Abstract

Introduction. Biliary tract brush cytology is increasingly being recognized as a favoured method for evaluating abnormalities of the pancreatic and biliary tract. In order to increase the diagnostic potential of endoscopic brushing of the biliary tract, we devised a novel technique finalized to the complete and ideal cytologic examination of the collected material through an original new brush processing method. Material and methods. 112 consecutive pancreato-biliary brush cytology specimens (67M; 45F) collected at Molinette Hospital, University of Turin, between January 2002 and August 2006 were included in our study. All patients had a definite final benign or malignant diagnosis based either on independent histological or cytological sampling, or on clinical follow-up data (follow-up was median 21 months). Immediately following brushing, the brush is immersed into methanol; then, in order to induce formation of a glue surrounding the brush, in the pathological laboratory it is immersed into egg albumen (a mixture 1:1 of egg albumen and glycerol), and finally returned to methanol. For paraffin embedding, the metal handling is cut away and the remaining brush is introduced into a cassette: paraffin-embedded sections parallel to the long axis of brush are cut until the metal wire is almost reached, then the block is rotated and new sections are obtained from the opposite side. Small fragments of the mucosa, of inflammatory cell aggregates or of carcinomas (stained in Haematoxylin & Eosin and Alcyan blue mucine) were observed in our series, and displayed an optimal fixation allowing a definite diagnosis which proved mandatory for proper therapy in the almost totality of cases. Results. The results obtained on 112 consecutive cases using such technique showed a satisfactory sensibility when compared to final histological diagnosis, this method showed: 87% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 91% negative predictive value (NPV). Moreover when compared this method to the patient clinical diagnosis, after at least 6 months follow-up, it showed: 88% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 96% negative predictive value (NPV). Conclusion. Finally such novel technique proved to be highly sensitive and specific, limiting the un-satisfactory cytological diagnoses to less than 1% and providing a 88% concordance (K value) with the final histology at surgery and a 91% concordance (K value) with patient follow-up.
2007
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316
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S. Asioli; G. Accinelli; E. Armando; D. Pacchioni; P. Cassoni; G. Bussolati
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/220660
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