title: Brush cytology is superior to biopsies obtained by a new device in bile duct strictures.
abstract: OBJECTIVE
  Brush cytology during ERCP has been reported to have a low sensitivity. A new device, Howell biliary system (Wilson-Cook), enables targeted biopsies for histopathologic assessment. The aim was to compare histopathology with brush cytology.
  
  
  METHODS
  Brush cytology followed by biopsies obtained by the Howell device was taken consecutively from bile duct strictures. Coded slides were scored by 3 pathologists and 2 cytologists in a 3-graded scale; 2: benign; 3: suspicious of malignancy; 4: malignant. The clinical outcome including autopsy served as the gold standard for the definite diagnoses.
  
  
  RESULTS
  Twenty-one malignant and 6 benign strictures were evaluated. The histopathology revealed 11 out of the 21 malignant as certain or suspected malignant (score > or = 3) (sensitivity: 0.52). The cytology scored 17 out of 21 > or = 3 (sensitivity: 0.80). The in pair kappa values for the 3 pathologists were: (0.37; 0.26; 0.41) vs. 0.56 for the 2 cytologists. Among the evaluable strictures the pathologists scorings were; (median: 3.0, SD: 0.72) for the malignant and (median: 2.3, SD: 0.98) for the benign (p = 0.27) and the cytology scorings were; (median: 3.5, SD: 0.73) for the malignant and (median: 2.7, SD: 0.65) for the benign (p = 0.09).
  
  
  CONCLUSIONS
  Brush cytology has a higher accuracy than the targeted biopsies and should be used in combination with other methods to reach the correct diagnosis.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine Kärnsjukhuset, University of Göteborg, SE-54185 Skövde, Sweden. k.ung@telia.com
authors.forename: Kjell-Arne
authors.initials: KA
authors.lastname: Ung
authors.forename: Annika
authors.initials: A
authors.lastname: Ljung
authors.forename: Jan
authors.initials: J
authors.lastname: Wågermark
authors.forename: Johan
authors.initials: J
authors.lastname: Lindholm
authors.forename: Lars
authors.initials: L
authors.lastname: Rydberg
authors.forename: Anders
authors.initials: A
authors.lastname: Kilander
authors.forename: P O
authors.initials: PO
authors.lastname: Stotzer
authors.forename: Pawel
authors.initials: P
authors.lastname: Burian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000473:pathology*; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000209:etiology / Q000473:pathology*; D003584:Cytological Techniques / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D015203:Reproducibility of Results