Bile duct brushings in a pig model

Examination of intraobserver variability and variability in specimen quality obtained in sequential animals and between two different brushes

William B. Silverman, Chris S. Jensen, Terri W. Crook, Andrew Henke

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose. In patients with bile duct malignancy, bile duct brushing is plagued by a low yield diagnosing underlying malignancy. There are few data explaining why this is so. This porcine model was designed to examine three variables: 1) examination of inter-observer variability, 2) variability in specimen quality obtained in sequential animals, and 3) variability between two different brushes (one designed for colon with large bristles, one for duodenum with short bristles). Methods. En bloc resection of liver, bile ducts, duodenum, and pancreas was performed on three 6-mo-old crossbred pigs at the time of commercial slaughter. In each pig, one common hepatic duct and one common bile duct brushing, all performed by the same investigator, were done. Ten identical vigorous passes were done with each brush (long bristle or short bristle) on virgin epithelium. Specimens were graded for cellularity by three cytopathologists who were blinded to the site or brush size. Interobserver variability as well as variability among sequential animals and between the two different brushes was compared. Results. Interobserver variability among the three cytologists was almost nil. Cellularity obtained using the short brush alone varied from unsatisfactory to high. Cellularity obtained using the long brush alone varied from unsatisfactory to moderate. Variability of cells obtained from one pig to the next ranged from unsatisfactory to high. Conclusions. 1) While interobserver variability was very low, variability in cellularity obtained from one pig to the next, and from one brush to the next, was very high. This sampling variability may partially explain the low yield in malignant cells in human malignant biliary brushing. Multiple brushings in one patient may alleviate part of this problem. 2) There was no advantage to either brush type (large bristle or small bristle).

Original languageEnglish (US)
Pages (from-to)31-34
Number of pages4
JournalInternational Journal of Gastrointestinal Cancer
Volume32
Issue number1
StatePublished - 2002

Fingerprint

Observer Variation
Bile Ducts
Swine
Duodenum
Common Hepatic Duct
Common Bile Duct
Pancreas
Neoplasms
Colon
Epithelium
Research Personnel
Liver

Keywords

  • Bile duct brush
  • ERCP
  • Tissue sampling

ASJC Scopus subject areas

  • Gastroenterology
  • Endocrinology
  • Oncology

Cite this

@article{a89292b4bc644900967d826f1f8d6614,
title = "Bile duct brushings in a pig model: Examination of intraobserver variability and variability in specimen quality obtained in sequential animals and between two different brushes",
abstract = "Purpose. In patients with bile duct malignancy, bile duct brushing is plagued by a low yield diagnosing underlying malignancy. There are few data explaining why this is so. This porcine model was designed to examine three variables: 1) examination of inter-observer variability, 2) variability in specimen quality obtained in sequential animals, and 3) variability between two different brushes (one designed for colon with large bristles, one for duodenum with short bristles). Methods. En bloc resection of liver, bile ducts, duodenum, and pancreas was performed on three 6-mo-old crossbred pigs at the time of commercial slaughter. In each pig, one common hepatic duct and one common bile duct brushing, all performed by the same investigator, were done. Ten identical vigorous passes were done with each brush (long bristle or short bristle) on virgin epithelium. Specimens were graded for cellularity by three cytopathologists who were blinded to the site or brush size. Interobserver variability as well as variability among sequential animals and between the two different brushes was compared. Results. Interobserver variability among the three cytologists was almost nil. Cellularity obtained using the short brush alone varied from unsatisfactory to high. Cellularity obtained using the long brush alone varied from unsatisfactory to moderate. Variability of cells obtained from one pig to the next ranged from unsatisfactory to high. Conclusions. 1) While interobserver variability was very low, variability in cellularity obtained from one pig to the next, and from one brush to the next, was very high. This sampling variability may partially explain the low yield in malignant cells in human malignant biliary brushing. Multiple brushings in one patient may alleviate part of this problem. 2) There was no advantage to either brush type (large bristle or small bristle).",
keywords = "Bile duct brush, ERCP, Tissue sampling",
author = "Silverman, {William B.} and Jensen, {Chris S.} and Crook, {Terri W.} and Andrew Henke",
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T1 - Bile duct brushings in a pig model

T2 - Examination of intraobserver variability and variability in specimen quality obtained in sequential animals and between two different brushes

AU - Silverman, William B.

AU - Jensen, Chris S.

AU - Crook, Terri W.

AU - Henke, Andrew

PY - 2002

Y1 - 2002

N2 - Purpose. In patients with bile duct malignancy, bile duct brushing is plagued by a low yield diagnosing underlying malignancy. There are few data explaining why this is so. This porcine model was designed to examine three variables: 1) examination of inter-observer variability, 2) variability in specimen quality obtained in sequential animals, and 3) variability between two different brushes (one designed for colon with large bristles, one for duodenum with short bristles). Methods. En bloc resection of liver, bile ducts, duodenum, and pancreas was performed on three 6-mo-old crossbred pigs at the time of commercial slaughter. In each pig, one common hepatic duct and one common bile duct brushing, all performed by the same investigator, were done. Ten identical vigorous passes were done with each brush (long bristle or short bristle) on virgin epithelium. Specimens were graded for cellularity by three cytopathologists who were blinded to the site or brush size. Interobserver variability as well as variability among sequential animals and between the two different brushes was compared. Results. Interobserver variability among the three cytologists was almost nil. Cellularity obtained using the short brush alone varied from unsatisfactory to high. Cellularity obtained using the long brush alone varied from unsatisfactory to moderate. Variability of cells obtained from one pig to the next ranged from unsatisfactory to high. Conclusions. 1) While interobserver variability was very low, variability in cellularity obtained from one pig to the next, and from one brush to the next, was very high. This sampling variability may partially explain the low yield in malignant cells in human malignant biliary brushing. Multiple brushings in one patient may alleviate part of this problem. 2) There was no advantage to either brush type (large bristle or small bristle).

AB - Purpose. In patients with bile duct malignancy, bile duct brushing is plagued by a low yield diagnosing underlying malignancy. There are few data explaining why this is so. This porcine model was designed to examine three variables: 1) examination of inter-observer variability, 2) variability in specimen quality obtained in sequential animals, and 3) variability between two different brushes (one designed for colon with large bristles, one for duodenum with short bristles). Methods. En bloc resection of liver, bile ducts, duodenum, and pancreas was performed on three 6-mo-old crossbred pigs at the time of commercial slaughter. In each pig, one common hepatic duct and one common bile duct brushing, all performed by the same investigator, were done. Ten identical vigorous passes were done with each brush (long bristle or short bristle) on virgin epithelium. Specimens were graded for cellularity by three cytopathologists who were blinded to the site or brush size. Interobserver variability as well as variability among sequential animals and between the two different brushes was compared. Results. Interobserver variability among the three cytologists was almost nil. Cellularity obtained using the short brush alone varied from unsatisfactory to high. Cellularity obtained using the long brush alone varied from unsatisfactory to moderate. Variability of cells obtained from one pig to the next ranged from unsatisfactory to high. Conclusions. 1) While interobserver variability was very low, variability in cellularity obtained from one pig to the next, and from one brush to the next, was very high. This sampling variability may partially explain the low yield in malignant cells in human malignant biliary brushing. Multiple brushings in one patient may alleviate part of this problem. 2) There was no advantage to either brush type (large bristle or small bristle).

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