title: Diagnostic accuracy of brush cytology with direct smear and cell-block techniques according to preparation order and tumor characteristics in biliary strictures.
abstract: OBJECTIVE
  There are few data supporting the diagnostic yield of brush cytology depending on the order of cytologic preparation method or the location or shape of tumors in biliary strictures. We investigated diagnostic yields and variations in brush cytology with direct smear and cell-block preparations according to sampling preparation sequence and tumor location and shape in biliary strictures.
  
  
  METHODS
  Patients who had undergone ERCP with tissue sampling between August 2009 and April 2013 were analyzed retrospectively. Group A was examined using brush cytology with direct smear followed by cell-block with or without biopsy, while the reverse order was performed for group B.
  
  
  RESULTS
  Among 138 enrolled patients, 92 patients (A: 36, B: 56) underwent both brush cytology with direct smear and cell-block preparations. No differences in sensitivity, specificity, or accuracy were observed according to the sampling preparation method and the location or shape of tumors in biliary strictures. The cellularity observed from brush cytology with direct smear was better than that from cell-block according to the location of the tumor (p<0.01). The diagnostic yield was increased in both groups with addition of an endobiliary biopsy.
  
  
  CONCLUSIONS
  No difference in diagnostic accuracy was observed between the sequences of preparation for brush cytology with direct smear and cell-block techniques. Brush cytology showed better cellularity for diagnosis.
authors.affiliation: Departments of Internal Medicine, Soonchunhyang University Hospital Cheonan, Korea.
authors.forename: Yeong Geol
authors.initials: YG
authors.lastname: Jo
authors.affiliation: Departments of Internal Medicine, Soonchunhyang University Hospital Cheonan, Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Departments of Internal Medicine and Pathology, Soonchunhyang University Hospital Cheonan, Korea.
authors.forename: Hyun Deuk
authors.initials: HD
authors.lastname: Cho
authors.affiliation: Departments of Internal Medicine, Soonchunhyang University Hospital Cheonan, Korea.
authors.forename: Sang Heum
authors.initials: SH
authors.lastname: Park
authors.affiliation: Departments of Internal Medicine, Soonchunhyang University Hospital Cheonan, Korea.
authors.forename: Jae Man
authors.initials: JM
authors.lastname: Park
authors.affiliation: Departments of Internal Medicine, Soonchunhyang University Hospital Cheonan, Korea.
authors.forename: Young Sin
authors.initials: YS
authors.lastname: Cho
authors.affiliation: Departments of Internal Medicine, Soonchunhyang University Hospital Cheonan, Korea.
authors.forename: Yunho
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Departments of Internal Medicine, Soonchunhyang University Hospital Cheonan, Korea.
authors.forename: Il-Kwun
authors.initials: IK
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Korea.
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine, Hospital Seoul, Soonchunhyang University College of Medicine, Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Cha
authors.affiliation: Department of Internal Medicine, Hospital Seoul, Soonchunhyang University College of Medicine, Korea.
authors.forename: Young Deok
authors.initials: YD
authors.lastname: Cho
authors.affiliation: Departments of Internal Medicine, Soonchunhyang University Hospital Cheonan, Korea.
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology*; D018281:Cholangiocarcinoma / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003581:Cytodiagnosis; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity