Reporting the presence of significant epithelial atypia in pancreaticobiliary brush cytology specimens lacking evidence of obvious carcinoma: impact on performance measures.
OBJECTIVE
To assess the clinical impact of recognizing and reporting the presence of significant atypia in brush cytology specimens from the biliary and pancreatic ducts lacking obvious features of carcinoma.


METHODS
Analysis of 120 pancreaticobiliary brushings from 99 patients over a 4-year period. There were 114 bile duct and 6 pancreatic duct specimens obtained via endoscopic retrograde cholangiopancreatography at a tertiary care center.


RESULTS
Overall sensitivity, specificity, accuracy, and positive and negative predictive values for carcinoma were 47%, 99%, 79%, 95% and 76%, respectively. When the presence of "significant epithelial abnormalities," cancer or cellular atypia less than carcinoma, was reported, the overall sensitivity, specificity, accuracy, and positive and negative predictive values were 62%, 93%, 82%, 85% and 80%, respectively.


CONCLUSIONS
Recognizing and reporting the presence of significant epithelial abnormalities in pancreaticobiliary specimens lacking obvious features of malignancy in brush cytology specimens led to a modest improvement in sensitivity for "significant epithelial abnormalities" and cancer, along with a slight decrease in specificity and positive predictive value and slightly increased accuracy and negative predictive value. Maintaining high specificity is essential to avoiding false positive diagnoses on pancreaticobiliary brush cytology.
Logroño
Roberto
R
Division of Cytopathology, Department of Pathology, University of Texas Medical Branch, Galveston, Texas 77555-0548, USA. rologron@utmb.edu
Wong
Jick Y
JY
D001659:Biliary Tract / Q000473:pathology*; D001661:Biliary Tract Neoplasms / Q000473:pathology*; D001706:Biopsy / Q000379:methods; D002277:Carcinoma / Q000473:pathology*; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D002467:Cell Nucleus / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002843:Chromatin / Q000473:pathology; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D004847:Epithelial Cells / Q000473:pathology*; D006801:Humans; D010183:Pancreatic Ducts / Q000473:pathology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D002843:Chromatin