Early Diagnosis of Pancreatobiliary Duct Malignancies by Brush Cytology and Biopsy

Gábor ELEK1, Tibor GYÖKERES2, Eszter SCHÄFER2, Mária BURAI2, Ferenc PINTÉR2, Ákos PAP2

1Department of Pathology, Central Railway Hospital and Polyclinic, Budapest, Hungary
2Department of Gastroenterology, Central Railway Hospital and Polyclinic, Budapest, Hungary


Two hundred and five preoperative intraductal samplings (brushing and biopsy) were evaluated from 113 patients with biliary or Wirsung duct strictures. One hundred and three strictures could be specified by histology of the operative specimens, autopsy, or by the patients’ clinical course. Preoperative diagnostic efficacy depended on the tumor location (it was the best for ampullary and parapapillary tumors), but the average quantitative indices for sensitivity, absolute sensitivity, specificity, positive and negative predictive values, diagnostic accuracy of cytology were 53%, 20%, 100%, 100%, 25%, 59%, respectively. The same values for biopsy were 43%, 34%, 100%, 100%, 36% and 56%. These figures improved after simultaneous cytology and biopsy. Close cooperation with the endoscopist was necessary in cases of negative, inconclusive and dysplastic (27%) samples. Repetition of sampling improved the results by 8%. Among the 26 preoperative false negative cases, sampling-, technical- and interpretative errors occurred in 84%, 4% and 12%, respectively. Revision of samples revealed 4 malignant cases among the false negative cytologic brushings. Reclassification of specimens considering the latest criteria - primary and secondary malignant features, pancreatic intraepithelial neoplasia (PanINs), etc. - resulted in improvement of the diagnostic efficiency. Pathology & Oncology Research, Vol 11, Nr 3, 145-155, 2005

Key words: intraductal biopsy; intraductal cytology; pancreatobiliary strictures; sensitivity and specificity; sampling-, processing- and interpretive errors

Received: Jan 26, 2005; accepted: Aug 1, 2005
Correspondence: Ákos PAP, Department of Gastroenterology, Central Railway Hospital and Polyclinic, Podmaniczky u. 111. Budapest H-1062, Hungary; Tel: +361 302 08 41, Fax: +361 475 26 69; E-mail:

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