INTRODUCTION Brush cytology is commonly used during endoscopic retrograde cholangiopancreatography for the diagnostic evaluation of biliopancreatic strictures. However, since the overall sensitivity of brush cytology is poor, the exclusion of malignancy is difficult. Recognition of factors related to the patient, technique or lesion may help improve the diagnostic yield of brush cytology. The objective of this study was to evaluate the diagnostic yield of brush cytology in the assessment of biliopancreatic strictures and identify predictive factors associated with a positive diagnosis of malignancy. METHODS Retrospective study that evaluated all consecutive patients that underwent brush cytology for the investigation of biliopancreatic strictures in a tertiary center, between January 2012 and January 2018. RESULTS One hundred and sixty-five patients that underwent 182 procedures were included. A diagnosis of malignancy was confirmed in 110 patients (66.7%), of whom 62 had positive brush cytology (sensitivity 53.7%, specificity 98.5%, accuracy 69.8%). On the multivariate analysis, age ≥68 years (OR 4.83, 95% CI 1.04-22.37) and lesions suspicious of metastasis on cross-sectional imaging (OR 8.58, 95% CI 1.70-43.38) were independently associated with a positive result. Subanalysis of the patients presenting with these two factors (n = 26) revealed an increase in the diagnostic yield (sensitivity 80.8%). CONCLUSION Age ≥68 years and lesions suspicious of metastasis on cross-sectional imaging are independent factors associated with a positive result. Patient selection taking these factors into account may increase the diagnostic yield of brush cytology.

中文翻译：

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评估胰胆管狭窄的刷细胞学性能。

简介刷细胞学常用于内镜逆行胰胆管造影术中，以诊断胆胰管狭窄。但是，由于刷细胞学的整体敏感性差，因此难以排除恶性肿瘤。识别与患者，技术或病变相关的因素可能有助于提高刷细胞学的诊断率。这项研究的目的是评估刷细胞学在评估胆胰狭窄方面的诊断率，并确定与恶性肿瘤阳性诊断相关的预测因素。方法回顾性研究评估了2012年1月至2018年1月间在三级中心接受刷细胞学检查的所有连续患者，以调查胆胰狭窄。结果纳入了182例手术的165例患者。确诊为恶性肿瘤的患者110例（66.7％），其中62例刷细胞学阳性（敏感性53.7％，特异性98.5％，准确性69.8％）。在多变量分析中，年龄≥68岁（OR 4.83，95％CI 1.04-22.37）和可疑的横断面转移灶（OR 8.58，95％CI 1.70-43.38）与阳性结果独立相关。对出现这两种因素的患者进行亚分析（n = 26）显示诊断率增加（敏感性为80.8％）。结论年龄≥68岁和可疑的病灶在横断面影像学检查中转移是与阳性结果相关的独立因素。