title: Improved endoscopic retrograde cholangiopancreatography brush increases diagnostic yield of malignant biliary strictures.
abstract: OBJECTIVE
  To determine if a new brush design could improve the diagnostic yield of biliary stricture brushings.
  
  
  METHODS
  Retrospective chart review was performed of all endoscopic retrograde cholangiopancreatography procedures with malignant biliary stricture brushing between January 2008 and October 2012. A standard wire-guided cytology brush was used prior to protocol implementation in July 2011, after which, a new 9 French wire-guided cytology brush (Infinity sampling device, US Endoscopy, Mentor, OH) was used for all cases. All specimens were reviewed by blinded pathologists who determined whether the sample was positive or negative for malignancy. Cellular yield was quantified by describing the number of cell clusters seen.
  
  
  RESULTS
  Thirty-two new brush cases were compared to 46 historical controls. Twenty-five of 32 (78%) cases in the new brush group showed abnormal cellular findings consistent with malignancy as compared to 17 of 46 (37%) in the historical control group (P = 0.0003). There was also a significant increase in the average number of cell clusters of all sizes (21.1 vs 9.9 clusters, P = 0.0007) in the new brush group compared to historical controls.
  
  
  CONCLUSIONS
  The use of a new brush design for brush cytology of biliary strictures shows increased diagnostic accuracy, likely due to improved cellular yield, as evidenced by an increase in number of cellular clusters obtained.
authors.affiliation: Frederick K Shieh, Harshit S Khara, Matthew J Shellenberger, Amitpal S Johal, David L Diehl, Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, United States.
authors.forename: Frederick K
authors.initials: FK
authors.lastname: Shieh
authors.affiliation: Frederick K Shieh, Harshit S Khara, Matthew J Shellenberger, Amitpal S Johal, David L Diehl, Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, United States.
authors.forename: Adelina
authors.initials: A
authors.lastname: Luong-Player
authors.affiliation: Frederick K Shieh, Harshit S Khara, Matthew J Shellenberger, Amitpal S Johal, David L Diehl, Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, United States.
authors.forename: Harshit S
authors.initials: HS
authors.lastname: Khara
authors.affiliation: Frederick K Shieh, Harshit S Khara, Matthew J Shellenberger, Amitpal S Johal, David L Diehl, Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, United States.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Liu
authors.affiliation: Frederick K Shieh, Harshit S Khara, Matthew J Shellenberger, Amitpal S Johal, David L Diehl, Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, United States.
authors.forename: Fan
authors.initials: F
authors.lastname: Lin
authors.affiliation: Frederick K Shieh, Harshit S Khara, Matthew J Shellenberger, Amitpal S Johal, David L Diehl, Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, United States.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Shellenberger
authors.affiliation: Frederick K Shieh, Harshit S Khara, Matthew J Shellenberger, Amitpal S Johal, David L Diehl, Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, United States.
authors.forename: Amitpal S
authors.initials: AS
authors.lastname: Johal
authors.affiliation: Frederick K Shieh, Harshit S Khara, Matthew J Shellenberger, Amitpal S Johal, David L Diehl, Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, United States.
authors.forename: David L
authors.initials: DL
authors.lastname: Diehl
keywords: Brush cytology; Cytopathology; Diagnostic yield; Endoscopic retrograde cholangiopancreatography; Malignant biliary stricture