So H, Jang SI, Ko SW, Yoon SB, Lee YS, Bang S, Kim M, Choi HJ. Effect of brush rinse on the diagnostic accuracy of biliary stricture evaluation: A multicenter trial. World J Clin Cases 2025; 13(15): 99212 [DOI: 10.12998/wjcc.v13.i15.99212]
Corresponding Author of This Article
Sung Woo Ko, PhD, Professor, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-Ro, Eunpyeong-Gu, Seoul 03312, South Korea. gogo930@catholic.ac.kr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 26, 2025; 13(15): 99212 Published online May 26, 2025. doi: 10.12998/wjcc.v13.i15.99212
Effect of brush rinse on the diagnostic accuracy of biliary stricture evaluation: A multicenter trial
Hoonsub So, Sung Ill Jang, Sung Woo Ko, Seung Bae Yoon, Young Sub Lee, SungJo Bang, Misung Kim, Hye-Jeong Choi
Hoonsub So, SungJo Bang, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea
Sung Ill Jang, Department of Internal Medicine, Institute of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
Sung Woo Ko, Seung Bae Yoon, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
Young Sub Lee, Department of Hospital Pathology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, South Korea
Misung Kim, Hye-Jeong Choi, Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea
Co-first authors: Hoonsub So and Sung Ill Jang.
Author contributions: So H was responsible for writing original draft; Jang SI was responsible for conceptualization; Ko SW was responsible for analysis, editing, and supervision; Yoon SB was responsible for additional statistics and analysis; Lee YS was responsible for data collection and slide review; Bang S was responsible for conceptualization and methodology; Kim M was responsible for data collection and slide review; Choi HJ was responsible for data collection and slide review; all of the authors read and approved the final version of the manuscript to be published.
Supported by The Catholic Medical Center Research Foundation Made in The Program Year of 2022.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of each center.
Informed consent statement: Written informed consent was obtained from all enrolled patients.
Conflict-of-interest statement: All authors disclose no financial relationships relevant to this publication.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sung Woo Ko, PhD, Professor, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-Ro, Eunpyeong-Gu, Seoul 03312, South Korea. gogo930@catholic.ac.kr
Received: July 17, 2024 Revised: December 20, 2024 Accepted: January 7, 2025 Published online: May 26, 2025 Processing time: 188 Days and 5.7 Hours
Abstract
BACKGROUND
Brush cytology is the most commonly used technique for tissue acquisition during endoscopic retrograde cholangiopancreatography for the evaluation of biliary strictures. Nonetheless, brush cytology is limited by its low sensitivity due to insufficient cellular yield.
AIM
To evaluate the impact of the sheath-rinse technique on improving the cellularity yield.
METHODS
A total of 112 patients with suspected malignant biliary strictures were enrolled at two tertiary centers in South Korea. The sample cellularity and diagnostic accuracy of brush-wash and sheath-rinse specimens were compared.
RESULTS
A significantly increased number of total cell clusters per representative 20 × field was recorded in the sheath-rinse compared with the brush-wash specimens (median: 12 vs 3, P < 0.001). This trend persisted when large (> 50 cells) clusters (median: 8 vs 3, P < 0.001), medium (6-49 cells) (median: 7 vs 3, P < 0.001), and small (2-5 cells) clusters (median: 9 vs 3, P < 0.001) were evaluated. Diagnostic accuracy and sensitivity for differentiating malignancy were superior with sheath-rinsing than with the brush-wash method (72.3% vs 62.5%, P < 0.001 and 69.9% vs 59.2%, P < 0.001, respectively).
CONCLUSION
Incorporating sheath-rinse specimens significantly improved the yield and diagnostic accuracy of biliary brush cytology. Sheath-rinsing should be integrated into routine clinical practice to improve diagnostic performance for biliary strictures.
Core Tip: Brush cytology is commonly used to collect tissue samples during endoscopic retrograde cholangiopancreatography for the evaluation of biliary strictures, but the diagnostic sensitivity of the method is limited because of an insufficient cellular yield. We evaluated whether sheath rinsing affects cellular yield. Our findings showed that the yield and diagnostic accuracy of biliary brush cytology improved significantly when sheath-rinsed specimens were assessed. This technique should be included in routine clinical practice to improve diagnostic performance for biliary strictures.
