title: A prospective randomised study of dense Infinity cytological brush versus regularly used brush in pancreaticobiliary malignancy.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreatography (ERCP) with a cytological sample is a valuable tool in the diagnosis of the aetiology of biliary stricture. Our aim was to evaluate whether a more dense Infinity® cytological brush is more sensitive in diagnosing malignancy than the regularly used brush.
  
  
  METHODS
  We recruited 60 patients with a biliary stricture suspicious for malignancy for a randomised controlled trial. Patients were randomly assigned to an Infinity® brush group (n = 30) and a regularly used cytology brush group (n = 30). All the patients had verified cancer during follow-up.
  
  
  RESULTS
  Crossing the brush over the stricture was possible in each case without dilatation of the biliary duct. Brush cytology yield was good or excellent in 86.7% of cases with the Infinity® brush and 96.7% with the regular brush (p = 0.161). The cytological sample showed clear malignancy in three patients (10.0%) in the Infinity® group and in 12 (40.0%) patients of the regular brush group (p = 0.007). The cytological diagnosis was highly suspicious for malignancy or malignant in 14 patients (46.7%) in the Infinity® group and in 23 patients (76.7%) in the regular brush group (p = 0.017). The result was benign in 10 patients (33.3%) in the Infinity® group and in four patients (13.6%) in the regular brush group (p = 0.067).
  
  
  CONCLUSIONS
  With the standardised technique, the sensitivity of brush cytology is fairly good. The dense Infinity® brush does not show any advantage regarding sensitivity compared with the conventional cytology brush.
authors.affiliation: a Department of Gastrointestinal and General Surgery , Helsinki University Central Hospital, HUS Abdominal Center , Helsinki , Finland ;
authors.forename: Leena
authors.initials: L
authors.lastname: Kylänpää
authors.affiliation: b HUSLAB, Helsinki University Hospital and University of Helsinki , Helsinki , Finland ;
authors.forename: Sonja
authors.initials: S
authors.lastname: Boyd
authors.affiliation: c Pathology, Research Programs Unit and HUSLAB , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Ristimäki
authors.affiliation: a Department of Gastrointestinal and General Surgery , Helsinki University Central Hospital, HUS Abdominal Center , Helsinki , Finland ;
authors.forename: Outi
authors.initials: O
authors.lastname: Lindström
authors.affiliation: a Department of Gastrointestinal and General Surgery , Helsinki University Central Hospital, HUS Abdominal Center , Helsinki , Finland ;
authors.forename: Marianne
authors.initials: M
authors.lastname: Udd
authors.affiliation: a Department of Gastrointestinal and General Surgery , Helsinki University Central Hospital, HUS Abdominal Center , Helsinki , Finland ;
authors.forename: Jorma
authors.initials: J
authors.lastname: Halttunen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000473:pathology*; D001661:Biliary Tract Neoplasms / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D003581:Cytodiagnosis / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D011446:Prospective Studies; D015203:Reproducibility of Results
keywords: Biliary stricture; ERCP; cytology; sensitivity