|
|
|
| Practical guide to improving diagnostic sensitivity of bile duct brushings |
| Ioannis C Varbobitis ∗, Jonathan C Booth , Cameron L Griffiths , Nishchay Chandra |
Department of Gastroenterology, Royal Berkshire Hospital, Reading RG1 5AN, UK
∗ Corresponding author.
E-mail address: Ioannis.Varmpompitis@nuh.nhs.uk (I.C. Varbobitis). |
|
|
|
|
Abstract Despite recent advances in hepatopancreatobiliary (HPB) endoscopy, pancreatobiliary (PB) tract brushing remains the first diagnostic approach in cases of indeterminate PB strictures. An accurate cytological diagnosis is critical to establishing an early and definite diagnosis before proceeding to aggressive chemotherapy regimens or major operations like a Whipple’s procedure. Nevertheless, the value of PB brushings is compromised by the fact that they have been historically characterized by low and variable sensitivity [1] and considerable intra- and inter-observer variability [2]. In an attempt to achieve a more objective interpretation of brushing specimens, cytological assessments have employed standardized reporting systems such as the classification proposed by the Papanicolaou Society of Cytopathology [3] which suggests classifying the reports into the following sub-categories: non-diagnostic, negative, atypical, neoplastic (benign or other), suspicious and positive. Nevertheless, a significant proportion of cytological assessments will still be compromised by inherent challenges in several components involved in the processes of sampling, preparation, examination and interpretation of brush smears.
|
|
|
|
|
|
|
|
|
2021, Vol. 20 
