Salomao Marcela, Gonda Tamas A, Margolskee Elizabeth, Eguia Vasco, Remotti Helen, Poneros John M, Sethi Amrita, Saqi Anjali
Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.
Cancer Cytopathol. 2015 Apr;123(4):244-52. doi: 10.1002/cncy.21509. Epub 2015 Jan 6.
Brush cytology is the initial intervention when evaluating biliary strictures. Biliary brush cytology is known for its low sensitivity (but high specificity) and may be accompanied by biopsies and/or fluorescent in situ hybridization (FISH) to improve diagnostic yield. This study aimed to identify features to enhance cytological sensitivity, and assess which sampling method(s) improve identification of pancreatobiliary adenocarcinomas (PBCa).
Seventy-three biliary stricture cases were retrieved (38 PBCa and 35 control benign strictures). Biliary brushings, FISH, and biopsies were reviewed. Cytology specimens were evaluated for cellularity and presence of drunken honeycomb (DH), loosely cohesive clusters of round cells (LCCRC), large atypical cells with foamy cytoplasm (LACF), and single vacuolated malignant cells (SCs). Biopsies were examined for the presence of stromal invasion (SI).
Biliary brushings were scantly cellular in 47.4% of PBCa and 51.4% of controls, resulting in 69.6% nondiagnostic/false-negative cytology diagnoses. DH, LACF, and SCs were significantly associated with adenocarcinoma (P < .00001, .0033, and .00002, respectively). By univariate analysis, SCs and LACF were predictors of malignancy in brushings (P = .0002 and .05). By multivariate analysis, only SCs were predictive of malignancy (P = .002). SI facilitated the diagnosis in 9 biopsies. Sensitivity/specificity of brush cytology, FISH, and biopsy were 39.5%/94.3%, 63.9%/94.3%, and 84.2%/100%, respectively.
The low sensitivity of biliary brushings results from limited cellularity. Identification of LACF, DH, and SCs improves sensitivity. Sampling of stromal tissue may facilitate PBCa diagnosis. Concurrent biopsies and FISH are helpful in enhancing the diagnostic yield of PBCa.
在评估胆管狭窄时，刷检细胞学是初始干预手段。胆管刷检细胞学以其低敏感性（但高特异性）而闻名，可能会结合活检和/或荧光原位杂交（FISH）以提高诊断率。本研究旨在确定增强细胞学敏感性的特征，并评估哪种采样方法能提高胰腺胆管腺癌（PBCa）的识别率。
回顾了73例胆管狭窄病例（38例PBCa和35例对照良性狭窄）。对胆管刷检、FISH和活检进行了复查。对细胞学标本评估细胞数量以及是否存在醉汉蜂窝状结构（DH）、松散聚集的圆形细胞（LCCRC）、具有泡沫状细胞质的大非典型细胞（LACF）和单个空泡化恶性细胞（SCs）。对活检标本检查是否存在间质浸润（SI）。
47.4%的PBCa和51.4%的对照病例中胆管刷检细胞数量稀少，导致69.6%的细胞学诊断为非诊断性/假阴性。DH、LACF和SCs与腺癌显著相关（分别为P <.00001、.0033和.00002）。单因素分析显示，SCs和LACF是刷检中恶性肿瘤的预测指标（P = .0002和.05）。多因素分析显示，只有SCs可预测恶性肿瘤（P = .002）。SI有助于9例活检的诊断。刷检细胞学、FISH和活检的敏感性/特异性分别为39.5%/94.3%、63.9%/94.3%和84.2%/100%。
胆管刷检的低敏感性源于细胞数量有限。识别LACF、DH和SCs可提高敏感性。间质组织采样可能有助于PBCa诊断。同时进行活检和FISH有助于提高PBCa的诊断率。
