Reporting the presence of significant epithelial atypia in pancreaticobiliary brush cytology specimens lacking evidence of obvious carcinoma: impact on performance measures.

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.