Factors affecting the yield of brush cytology for the diagnosis of pancreatic and biliary cancers.
OBJECTIVE
Pancreatobiliary malignancies often present as biliary strictures. Biliary brush cytology is an established diagnostic technique in the investigation of such strictures. The main shortcoming of the test, however, is its low sensitivity. The aim of this was to identify factors associated with a positive yield on biliary brush cytology.


METHODS
Consecutive patients who had brush cytology for investigation of biliary strictures from 2005 to 2007 were included. Association of several factors with a positive result on brush cytology was studied using univariable and multivariable logistic regression analyses.


RESULTS
Two hundred eighty patients were evaluated. One hundred nineteen (42.5%) patients had a final diagnosis of malignancy; of whom, 55 had a positive brush cytology (sensitivity, 46%; specificity, 100%). On multivariable analysis, age (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.06-10.4 per 5-year increase), total serum bilirubin levels (OR, 1.3; 95% CI, 1.01-1.6 per 5-unit increase), and presence of a mass on cross-sectional imaging (OR, 11.7; 95% CI 5.1-27.2) were independent predictors of a positive brush cytology result.


CONCLUSIONS
Increasing age, higher serum bilirubin levels, and presence of a mass on cross-sectional imaging are independent factors associated with a positive result on biliary brush cytology. These findings suggest use of complementary tissue acquisition techniques in selected cases.
Parsi
Mansour A
MA
Center for Endoscopy and Pancreatobiliary Disorders, Digestive Disease Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, USA. parsim@ccf.org
Deepinder
Fnu
F
Lopez
Rocio
R
Stevens
Tyler
T
Dodig
Milan
M
Zuccaro
Gregory
G
D000367:Age Factors; D000368:Aged; D001661:Biliary Tract Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015331:Cohort Studies; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies