Agreement between endoscopic ultrasound-guided fine-needle aspiration and endobiliary brush cytology in suspected pancreaticobiliary malignancies

Abstract

Background and study aims For suspected pancreaticobiliary malignancies, endobiliary brush cytology during endoscopic retrograde cholangiopancreatography (ERCP) remains the diagnostic test of choice despite historically poor and variable sensitivity. This has led to increased use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) as an initial test. Recently, our institution began using a cytology brush that was designed specifically to collect a more substantial and higher-quality sample. The aim of this study was to investigate whether this brush design would provide more adequate samples and have high agreement with EUS-FNA in patients who underwent both procedures.

Patients and methods A retrospective chart review was conducted of all patients who underwent both EUS-FNA and endobiliary brush cytology for suspicion of pancreaticobiliary malignancy from January 2013 to May 2015. A total of 41 patients met the inclusion criteria. Initially, sample quality was evaluated. Final cytology results were then assessed for agreement with EUS-FNA using Cohen’s kappa. The effect of considering atypical cytology as negative was also uniquely evaluated by running separate analyses.

Results Brush cytology provided an adequate sample in 95.1 % of cases. Cohen’s Kappa demonstrated moderate agreement between brush cytology and EUS-FNA: κ = 0.42 (P = 0.001). When atypical results were excluded, agreement increased: κ = 0.60 (P = 0.02), but remained moderate. If atypical results were considered “positive,” the two procedures demonstrated equal cancer detection rates of 80.8 %.

Conclusions The studied brush provided more adequate samples compared with historical rates for brush cytology and had moderate agreement with EUS-FNA. If this brush truly increases sample adequacy, it could potentially provide results comparable to EUS-FNA at lower cost.

• References

• 1 Ryan DP, Hong TS, Bardeesy N. Pancreatic Adenocarcinoma. N Engl J Med 2014; 371: 1039-1049
• 2 Rizvi S, Gores GJ. Pathogenesis, diagnosis, and management of cholangiocarcinoma. Gastroenterology 2013; 145: 1215-1229
• 3 Rösch T, Hofrichter K, Frimberger E. et al. ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc 2004; 60: 390-396
• 4 Osnes M, Serck-Hanssen A, Myren J. Endoscopic retrograde brush cytology (ERBC) of the biliary and pancreatic ducts. Scand J Gastroenterol 1975; 10: 829-831
• 5 Victor DW, Sherman S, Karakan T. et al. Current endoscopic approach to indeterminate biliary strictures. World J Gastroenterol 2012; 18: 6197-6205
• 6 Salomao M, Gonda TA, Margolskee E. et al. Strategies for improving diagnostic accuracy of biliary strictures. Cancer Cytopathol 2015; 123: 244-252
• 7 Hammoud GM, Almashhrawi A, Ibdah JA. Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of hepatic, gallbladder and biliary tract lesions. World J Gastrointest Oncol 2014; 6: 420-429
• 8 Weilert F, Bhat YM, Binmoeller KF. et al. EUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction: results of a prospective, single-blind, comparative study. Gastrointest Endosc 2014; 80: 91-104
• 9 Lee JG, Leung JW, Baillie J. et al. Benign, dysplastic, or malignant – making sense of endoscopic bile duct brush cytology: results in 149 consecutive patients. Am J Gastroenterol 1995; 90: 722-726
• 10 Uchida N, Kamada H, Tsutsui K. et al. Utility of pancreatic duct brushing for diagnosis of pancreatic carcinoma. J Gastroenterol 2007; 42: 657-662
• 11 Fogel EL, deBellis M, McHenry L. et al. Effectiveness of a new long cytology brush in the evaluation of malignant biliary obstruction: a prospective study. Gastrointest Endosc 2006; 63: 71-77
• 12 Logrono R, Kurtycz DF, Molina CP. et al. Analysis of false-negative diagnoses on endoscopic brush cytology of biliary and pancreatic duct strictures: the experience at 2 university hospitals. Arch Pathol Lab Med 2000; 124: 387-392
• 13 Yoon WJ, Brugge WR. Endoscopic evaluation of bile duct strictures. Gastrointest Endosc Clin N Am 2013; 23: 277-293
• 14 Gaidos JK, Draganov P. Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents. World J Gastroenterol 2009; 73: 71-78
• 15 Parasher VK, Huibregtse K. Endoscopic retrograde wire-guided cytology of malignant biliary strictures using a novel scraping brush. Gastrointest Endosc 1998; 48: 288-290
• 16 US Endoscopy Infinity^® ERCP sampling device. http://www.usendoscopy.com/~/media/Files/Documents/Spec-Sheet-US/infinity_ss_us_760699C.pdf
• 17 Shieh FK, Luong-Player A, Khara HS. et al. Improved endoscopic retrograde cholangiopancreatography brush increases diagnostic yield of malignant biliary strictures. World J Gastrointest Endosc 2014; 6: 312-317
• 18 Kylanpaa L, Boyd S, Ristimaki A. et al. A prospective randomised study of dense Infinity cytological brush versus regularly used brush in pancreaticobiliary malignancy. Scand J Gastroenterol 2016; 51: 590-593
• 19 Pitman MB, Layfield LJ. Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: a review. Cancer Cytopathol 2014; 122: 399-411
• 20 Eiholm S, Thielsen P, Kromann-Anderson H. Endoscopic brush cytology from the biliary duct system is still valuable. Dan Med J 2013; 60: A4656
• 21 Paquin SC, Gariepy G, Lepanto L. et al. A first report of tumor seeding because of EUS-guided FNA of a pancreatic adenocarcinoma. Gastrointest Endosc 2005; 61: 610-611
• 22 Katanuma A, Maguchi H, Hashigo S. et al. Tumor seeding after endoscopic ultrasound-guided fine-needle aspiration of cancer in the body of the pancreas. Endoscopy 2012; 44: E160-E161
• 23 Chong A, Venugopal K, Segarajasingam D. et al. Tumor seeding after EUS-guided FNA of pancreatic tail neoplasia. Gastrointest Endosc 2001; 74: 933-935
• 24 Ahmed K, Sussman JJ, Wang J. et al. A case of EUS-guided FNA-related pancreatic cancer metastasis to the stomach. Gastrointest Endosc 2011; 74: 231-233
• 25 Rosen CB, Heimbach JK, Gores GJ. Liver transplantation for cholangiocarcinoma. Transpl Int 2010; 32: 692-697