Team approach to ERCP-directed single-brush cytology for the diagnosis of malignancy

Objective: to evaluate the clinical usefulness of single-brush cytology performed at ERCP as initial method for detecting pan creatobiliary malignancy, ensuring a very close relationship be tween endoscopists, cytotechnicians, and cytopathologists. Study design: all 125 cytodiagnoses considered in this study correspond to the first brushing for each patient, collected by one of the three members of a fixed team of endoscopists in the pres ence of the same cytotechnician. Smears were fixed immediately with Merckofix ® spray, stained with Papanicolau, and analyzed by the same cytopathologist in a laboratory exclusively devoted to gastrointestinal cytopathology located at the endoscopy unit. Results: of 125 cytological diagnoses 94 were considered be nign, 4 suspicious, and 27 malignant. These findings were com pared to the final diagnosis of 45 malignant and 80 benign lesions obtained either by surgical pathology or after at least one year of clinical follow-up. The comparison yielded 30 true positives, 78 true negatives, 1 false positive and 16 false negative results, which corresponds to a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 65.2, 98.7, 96.8, 83, and 86.4%, respectively. Conclusion: results seem to confirm the usefulness of an ef fective team approach to ERCP-directed brush cytology for the diagnosis of pancreatobiliary malignancy. However, sensitivity con tinues to be rather low.