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Comparison of brush and basket cytology in differential diagnosis of bile duct stricture at endoscopic retrograde cholangiopancreatography

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Hepatobiliary & Pancreatic Diseases International 2014年第6期13卷 622-627页

作者： Ki Bae Bang Hong Joo Kim Jung Ho Park Dong Il Park Yong Kyun Cho Chong Il Sohn Woo Kyu Jeon Byung Ik Kim Department of Internal Medicine Sungkyunkwan University Kangbuk Samsung Hospital 108 Pyung-Dong Jongro-Ku Seoul 110-746 Korea

BACKGROUND： A previous report has identified a significantly higher sensitivity of cancer detection for dedicated grasping basket than brushing at endoscopic retrograde cholangiopancreato- graphy （ERCP）. This study aimed to compare the diagnostic accuracy of Geenen brush and Dormia basket cytology in the differential diagnosis of bile duct stricture. METHOD： The current study enrolled one hundred and fourteen patients who underwent ERCP with both Geenen brush and Dormia basket cytology for the differential diagnosis of bile duct stricture at our institution between January 2008 and December 2012. RESULTS： We adopted sequential performances of cytologic samplings by using initial Geenen brush and subsequent Dormia basket cytology in 59 patients and initial Dormia basket and subsequent Geenen Brush cytology in 55 patients. Presampling balloon dilatations and biliary stentings for the stricture were performed in 17 （14.9%） and 107 patients （93.9%）, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Geenen Brush cytology for the diagnosis of malignant bile duct stricture were 75.0%, 100.0%, 100.0%, 66.7% and 83.3%, respectively, and those of Dormia basket cytology were 64.5%, 100.0%, 100.0%, 58.5% and 76.3%, respectively （P=0.347 and 0.827 for sensitivity and accuracy, respectively）. The good and excellent cellular yields （≥grade 2） were obtained by Geenen brush and Dormia basket cytology in 88 （77.2%） and 79 （69.3%） patients, respectively.CONCLUSION： The sensitivity, specificity and accuracy of biliary sampling with a Dormia basket are comparable to those with conventional Geenen Brush cytology in the detection of malignant bile duct stricture.

关键词： bile duct stricture cholangiocarcinoma Brush cytology basket cytology

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Suspicious Brush cytology is an indication for liver transplantation evaluation in primary sclerosing cholangitis

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World Journal of Gastroenterology 2017年第33期23卷 6147-6154页

作者： Sonja Boyd Marko Vannas Kalle Jokelainen Helena Isoniemi Heikki Makisalo Martti A Farkkila Johanna Arola Department of Pathology University of Helsinki and Helsinki University Hospital Transplantation and Liver Surgery Clinic University of Helsinki and Helsinki University Hospital Clinic of Gastroenterology University of Helsinki and Helsinki University Hospital

AIM To investigate markers for high-grade dysplasia for the optimal timing of liver transplantation in patients with primary sclerosing cholangitis(PSC).METHODS Earlier data support a dysplasia-carcinoma sequence,even low-to high-grade dysplasia,in PSC-associated cholangiocarcinoma(CCA). Surveillance using endoscopic retrograde cholangiography(ERC) and Brush cytology aims to detect cases of biliary dysplasia,and liver transplantation is an option in cases with suspicion of malignancy in brushing. This study investigated markers to identify patients with highgrade biliary dysplasia for optimal timing in early liver transplantation. Patients undergoing surveillance using ERC and Brush cytology during 2008-2014 and who were diagnosed with biliary dysplasia in explanted liver or CCA until February 2016 were included in the study. Demographic data,cholangiography findings,laboratory values,cytological morphology and DNA ploidy were analysed.RESULTS Thirty PSC patients had biliary neoplasia in the explanted liver during the study period. Sixteen of these patients had low-grade dysplasia,10 patients had high-grade dysplasia,and 4 patients had CCA. Fifteen PSC patients diagnosed with CCA were not transplanted. Patients with low-grade dysplasia were younger. Alkaline phosphatase or carcinoembryonic antigen values did not differ between groups during surveillance,but carbohydrate antigen 19-9 was higher in CCA patients. No difference in PSC duration,ERC scores,suspicious cytology,or ploidy analysis was found between groups. No difference was observed between fibrosis stage in explanted livers. Low-and high-grade dysplasia could not be differentiated before liver transplantation based on liver enzymes,tumour markers,ERC scores,Brush cytology or DNA ploidy.CONCLUSION Repeated suspicion of neoplasia in Brush cytology should be an indication for evaluations of liver transplantation prior to the development of CCA.

关键词： Endoscopic retrograde cholangiography Brush cytology Cholangiocarcinoma Biliary dysplasia

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