Objective. Obtaining cytological specimens by wire-guided endobiliary brushing at the time of endoscopic retrograde cholangiopancreatography (ERCP) is a convenient way to reach a diagnosis. Sensitivity for malignant d...Objective. Obtaining cytological specimens by wire-guided endobiliary brushing at the time of endoscopic retrograde cholangiopancreatography (ERCP) is a convenient way to reach a diagnosis. Sensitivity for malignant disease is generally around 50%and specificity around 100%. The present study was designed to assess the reproducibility of the cytological examination. Material and methods. Samples were obtained from 55 consecutive patients with biliary duct strictures that eventually turned out to be caused by malignant disease in 41 patients (73%). The cytology specimens were evaluated twice in different random order with an interval of at least 4 months by two pathologists blinded to the final diagnoses. Suitability for diagnosis (suitable, suboptimal or unsuitable) and cytologic diagnosis (benign, atypical, suspicious for malignancy and malignant cells) were registered. Kappa analysis was applied. Results. Regarding suitability for diagnosis, the two observers reproduced their findings in 84%(kappa 0.76) and 87%(0.59) (p >0.05), while the interobserver variations on the two occasions were 76%and 78%(kappa 0.49 and 0.58, respectively) (p > 0.05). Five percent of samples were rated as inadequate for diagnosis in at least one reading; 18%were suboptimal and 62-82%were suitable. The observers reproduced their cytological diagnosis in 77%and 71%(weighted kappa 0.83 and 0.75) (p > 0.05), and agreed on the cytological diagnosis in 65%and 73%(weighted kappa 0.65 and 0.75) (p > 0.05). Conclusions. The intra-and interobserver agreement in cytological evaluation of endobiliary brushings from bile duct strictures is generally good. The rates of inadequate and suboptimal samples can probably be reduced by modifications of the brush design.展开更多
Background and study aims: The aim of the present study was to analyze the reasons for false findings on computed tomographic (CT) colonography. Patients and methods: A total of 100 consecutive CT colonography examina...Background and study aims: The aim of the present study was to analyze the reasons for false findings on computed tomographic (CT) colonography. Patients and methods: A total of 100 consecutive CT colonography examinations were carried out before conventional colonoscopies scheduled on the same day. Before the study, an experienced radiologist received training in analyzing CT colonographies. The radiologists and endoscopists were blinded to each others findings. The patients received standard polyethylene glycol bowel preparation and were scanned in the prone and supine positions using a helical CT scanner and commercially available software for image analysis. Each pair of examinations was later followed by an unblinded analysis, comparing the CT colonographies with video recordings of the conventional colonographies in order to determine the reasons for tumors being missed or false- positive diagnoses arising on CT colonography. Results: Ninety polyps were detected in 41 patients. For patients with tumors ≥ 5 mm and ≥ 10mm, the sensitivity was 67% and 75% , respectively, and the specificity was 84% and 95% , respectively. The most important reasons for the 38 false findings of tumors ≥ 5 mm were perception errors (21 of 38) and misinterpretation of flat lesions in particular, including a high- grade dysplasia and a flat elevated Dukes A carcinoma. Residual stool was frequently the reason for misinterpreting lesions ≥ 10 mm (four of 10). Conclusions: Perception errors were the main reason for false findings of lesions ≥ 5 mm, including one flat malignant lesion. Residual stool caused four of 10 false findings for lesions ≥ 10 mm. Reading CT colonographies requires a high level of expertise, and conventional colonography is still regarded as the gold standard for detecting colorectal lesions.展开更多
文摘Objective. Obtaining cytological specimens by wire-guided endobiliary brushing at the time of endoscopic retrograde cholangiopancreatography (ERCP) is a convenient way to reach a diagnosis. Sensitivity for malignant disease is generally around 50%and specificity around 100%. The present study was designed to assess the reproducibility of the cytological examination. Material and methods. Samples were obtained from 55 consecutive patients with biliary duct strictures that eventually turned out to be caused by malignant disease in 41 patients (73%). The cytology specimens were evaluated twice in different random order with an interval of at least 4 months by two pathologists blinded to the final diagnoses. Suitability for diagnosis (suitable, suboptimal or unsuitable) and cytologic diagnosis (benign, atypical, suspicious for malignancy and malignant cells) were registered. Kappa analysis was applied. Results. Regarding suitability for diagnosis, the two observers reproduced their findings in 84%(kappa 0.76) and 87%(0.59) (p >0.05), while the interobserver variations on the two occasions were 76%and 78%(kappa 0.49 and 0.58, respectively) (p > 0.05). Five percent of samples were rated as inadequate for diagnosis in at least one reading; 18%were suboptimal and 62-82%were suitable. The observers reproduced their cytological diagnosis in 77%and 71%(weighted kappa 0.83 and 0.75) (p > 0.05), and agreed on the cytological diagnosis in 65%and 73%(weighted kappa 0.65 and 0.75) (p > 0.05). Conclusions. The intra-and interobserver agreement in cytological evaluation of endobiliary brushings from bile duct strictures is generally good. The rates of inadequate and suboptimal samples can probably be reduced by modifications of the brush design.
文摘Background and study aims: The aim of the present study was to analyze the reasons for false findings on computed tomographic (CT) colonography. Patients and methods: A total of 100 consecutive CT colonography examinations were carried out before conventional colonoscopies scheduled on the same day. Before the study, an experienced radiologist received training in analyzing CT colonographies. The radiologists and endoscopists were blinded to each others findings. The patients received standard polyethylene glycol bowel preparation and were scanned in the prone and supine positions using a helical CT scanner and commercially available software for image analysis. Each pair of examinations was later followed by an unblinded analysis, comparing the CT colonographies with video recordings of the conventional colonographies in order to determine the reasons for tumors being missed or false- positive diagnoses arising on CT colonography. Results: Ninety polyps were detected in 41 patients. For patients with tumors ≥ 5 mm and ≥ 10mm, the sensitivity was 67% and 75% , respectively, and the specificity was 84% and 95% , respectively. The most important reasons for the 38 false findings of tumors ≥ 5 mm were perception errors (21 of 38) and misinterpretation of flat lesions in particular, including a high- grade dysplasia and a flat elevated Dukes A carcinoma. Residual stool was frequently the reason for misinterpreting lesions ≥ 10 mm (four of 10). Conclusions: Perception errors were the main reason for false findings of lesions ≥ 5 mm, including one flat malignant lesion. Residual stool caused four of 10 false findings for lesions ≥ 10 mm. Reading CT colonographies requires a high level of expertise, and conventional colonography is still regarded as the gold standard for detecting colorectal lesions.
