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[Intestinal brushing. Technical-cytological contribution in the pathological study of Vater's ampulla, common bile
V Villanacci1, E Padova, M Bonardi
12o Servizio di Anatomia Patologica, Spedali Civili, Brescia.
Objective:
This experience shows the effectiveness of the cytological examination in the diagnosis of biliary and pancreatic neoplasm on samples obtained from Vater's papilla through endoscopic intestinal brushing.
Study Design:
From June 1997 to October 1998, 28 patients, suffering from suspicious neoplasm of Vater's papilla or biliary system, were studied. Each sample was obtained through intestinal brushing during an Endoscopic Retrograde Colangio-Pancreatography (ERCP) and processed with the technique of direct smear stained with Papanicolaou's method. The sample was followed by the corresponding biopsy in 16 cases and by surgical specimens in 8 cases.
Results:
27 patients out of 28 were correctly classified by the intestinal brushing. The method carried out a positive predictive value of 100% and a sensitivity of 93%. The sensitivity of biopsy turned out to be 80%.
Conclusions:
The intestinal brushing is an effective method of diagnosis, which turned out to be relevant as a support and, in several cases, as a substitute of the biopsy. We think, therefore, that the brushing should be carried out whenever a lesion of the Vater's papilla or of the biliary system is suspected during an ERCP.