Reporting the Presence of Signi.cant Epithelial Atypia in Pancreaticobiliary Brush Cytology Specimens Lacking Evidence of Obvious Carcinoma

Abstract

OBJECTIVE: To assess the clinical impact of recognizing and reporting the presence of significant atypia in brush cytology specimens from the biliary and pancreatic ducts lacking obvious features of carcinoma. STUDY DESIGN: Analysis of 120 pancreaticobiliary brushings from 99 patients over a 4-year period. There were 114 bile duct and 6 pancreatic duct specimens obtained via endoscopic retrograde cholangiopancreatography at a tertiary care center. RESULTS: Overall sensitivity, specificity, accuracy, and positive and negative predictive values for carcinoma were 47%, 99%, 79%, 95% and 76%, respectively. When the presence of "significant epithelial abnormalities," cancer or cellular atypia less than carcinoma, was reported, the overall sensitivity, specificity, accuracy, and positive and negative predictive values were 62%, 93%, 82%, 85% and 80%, respectively. CONCLUSION: Recognizing and reporting the presence of significant epithelial abnormalities in pancreaticobiliary specimens lacking obvious features of malignancy in brush cytology specimens led to a modest improvement in sensitivity for "significant epithelial abnormalities" and cancer, along with a slight decrease in specificity and positive predictive value and slightly increased accuracy and negative predictive value. Maintaining high specificity is essential to avoiding false positive diagnoses on pancreaticobiliary brush cytology.