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01-02-2018 | Hepatobiliary-Pancreas

Fluoroscopic percutaneous brush cytology, forceps biopsy and both in tandem for diagnosis of malignant biliary obstruction

Authors: Johannes Boos, Raphael J. Yoo, Jennifer Steinkeler, Gamze Ayata, Muneeb Ahmed, Ammar Sarwar, Jeffrey Weinstein, Salomao Faintuch, Olga R. Brook

Published in: European Radiology | Issue 2/2018

Abstract

Objectives

To evaluate percutaneous brush cytology, forceps biopsy and a tandem procedure consisting of both, in the diagnosis of malignant biliary obstruction.

Methods

A retrospective review of consecutive patients who underwent biliary brush cytology and/or forceps biopsy between 01/2010 and 09/2014 was performed. The cytology and pathology results were compared to the composite outcome (including radiological, pathological and clinical data). Cost for tandem procedure compared to brush cytology and forceps biopsy alone was calculated.

Results

A total of 232 interventions in 129 patients (70.8 ± 11.0 years) were included. Composite outcome showed malignancy in 94/129 (72.9%) patients. Sensitivity for brush cytology, forceps biopsy and tandem procedure was 40.6% (95% CI 32.6–48.7%), 42.7% (32.4–53.0%) and 55.8% (44.7–66.9%) with 100% specificity, respectively. There were 9/43 (20.9%) additional cancers diagnosed when forceps biopsy was performed in addition to brush cytology, while there were 13/43 (30.2%) more cancers diagnosed when brush cytology was performed in addition to forceps biopsy. Additional costs per additionally diagnosed malignancy if tandem approach is to be utilised in all cases was $704.96.

Conclusion

Using brush cytology and forceps biopsy in tandem improves sensitivity compared to brush cytology and forceps biopsy alone in the diagnosis of malignant biliary obstruction.

Key points

• Tandem procedure improves sensitivity compared to brush cytology and forceps biopsy.

• Brush cytology may help to overcome “crush artefacts” from forceps biopsy.

• The cost per diagnosed malignancy may warrant tandem procedure in all patients.

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Title: Fluoroscopic percutaneous brush cytology, forceps biopsy and both in tandem for diagnosis of malignant biliary obstruction
Authors: Johannes Boos
Raphael J. Yoo
Jennifer Steinkeler
Gamze Ayata
Muneeb Ahmed
Ammar Sarwar
Jeffrey Weinstein
Salomao Faintuch
Olga R. Brook
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 2/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4987-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Fluoroscopic percutaneous brush cytology, forceps biopsy and both in tandem for diagnosis of malignant biliary obstruction

Abstract

Objectives

Methods

Results

Conclusion

Key points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key points

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