A275 REVISITING THE DIAGNOSTIC YIELD OF ERCP BRUSH CYTOLOGY FOR INDETERMINATE BILIARY STRICTURES

Background

Endoscopic Retrograde Cholangiopancreatography (ERCP) brush cytology is the most frequently used tool for sampling indeterminate biliary strictures. Previous studies have demonstrated that the diagnostic yield of brush cytology for malignant biliary strictures is 60%. With improved diagnostic tools, sampling techniques and specimen processing, the yield of ERCP brush cytology may be higher.

Aims

To assess the diagnostic yield of ERCP brush cytology in patients with indeterminate biliary strictures and to determine factors associated with positive diagnosis.

Methods

This is a retrospective study of all patients who underwent ERCP with brush cytology at University Health Network (UHN) from October 2016 to September 2019. The cytological samples were taken as follows: the cytology brush is introduced into the stricture ten times under direct fluoroscopy guidance. The brush was cut and placed into a methanol based buffered solution (CytoLyt®). Residual sample was then flushed out of the catheter with the solution and into the sample container. Patient demographic, clinical, procedural and pathological data was collected by chart review. All patients were followed for a minimum of three months after their index ERCP. Post-ERCP sampling via repeat ERCP brushings, endoscopic ultrasound fine needle biopsy, percutaneous biopsy or surgical resection was recorded.

Results

A total of 97 patients underwent ERCP with brush cytology during the study period (43 females, median age 69 years). Fifty-nine patients (84%) were diagnosed with malignancy via ERCP brush cytology. Using follow up sampling, surgical resection and clinical follow up as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 84%, 100%, 100%, and 71% respectively. Patient demographics, degree of cholestasis or stricture location had no significant impact on these outcomes.

Conclusions

This study shows a high diagnostic yield for ERCP with brush cytology for patients with indeterminate biliary strictures. Large prospective studies using updated tools, techniques and specimen handling processes are needed to confirm our observations.

Funding Agencies

None

Worrisome histologic alterations following fine-needle aspiration of the parathyroid

Fine-needle aspiration (FNA) is a procedure that is increasingly being performed. Artefacts occurring after FNA are reported to complicate the histological analysis of the tissue, mainly in the thyroid; WHAFFT (worrisome histologic alterations following FNA of thyroid) is well documented in the literature. The case of a male patient with hypercalcaemia who was subsequently found to have a nodule in the thyroid gland is reported here. He underwent FNA, followed by a total thyroidectomy and parathyroidectomy. The abnormality in the parathyroid gland showed worrisome histological changes that were suspicious of a malignant lesion, resembling the changes seen in the thyroid gland after FNA. Parathyroid cells were identified by a review of the previous FNA. The concept of WHAFFT, which can mimic the features of malignancy in the parathyroid gland, is therefore introduced.

Freiwillig mehr tun? Organizational Citizenship Behavior im Krankenhaus - ein Vergleich zwischen Ärzten und Pflegekräften

AIM OF THE STUDY

The study compares physicians and the nursing staff of a hospital in terms of their extra-role behavior. Matters of interest include the extent of Organizational Citizenship Behavior (OCB) shown on the one hand and on the other hand which conditions stimulate the OCB of both physicians and nurses, respectively.

METHOD

The comparison was conducted by applying a questionnaire on n = 70 physicians and n = 112 nurses in a nursing department of a municipal hospital.

RESULTS

The results can be summarized as follows: (1) The extra-role behavior in terms of sportsmanship, individual initiative, and conscientiousness show equally high values with respect to physicians as well as nurses. In contrast, nurses rate their own helping behavior towards colleagues higher than the physicians do. Therefore, the extent of OCB does not seem to be job-specific in the narrower sense. (2) Differences between physicians and nurses exist indeed with respect to the conditions for the occurrence of OCB: Although the extent of OCB shown by physicians and nurses is independent from age, department tenure, and organizational tenure, job experience does play a role for the degree of conscientiousness (physicians) and individual initiative (nurses). Furthermore, gender affects the sub dimension sportsmanship (nurses). (3) While job characteristics (job control and stress) play a certain role for the degree of nurses' OCB, the physicians' extra-role behavior is independent from job control and strain. Vice versa, the analyzed person-related characteristics job insecurity and strain play a role for the extra-role behavior of physicians, while the behavior of nurses remains unaffected hereof. In other words: Nurses show the same OCB at high and low levels of strain and job insecurity, while physicians lower their OCB when strain and job insecurity rise. (4) For both physicians and nurses, job satisfaction is the most important predictor for extra-role behavior.

CONCLUSION

When trying to enhance the extent of OCB within a hospital, it is -- according to our results -- primarily essential to increase the job satisfaction of physicians as well as nurses. Within the nursing department, it is additionally recommended to enhance the employees' scope of action, if possible. However, for the enhancement of OCB it must be kept in mind -- according to our results -- that with rising OCB the stress (e. g. time pressure and interruptions) rise at the same time. The latter might result in higher strain for employees. In the group of physicians, on the other hand, a person-related approach seems promising: it is essential to reduce the physicians' subjectively felt strains as well as the job insecurity.

Ultrasound-guided fine-needle aspiration (FNA) of nonpalpable breast lesions: a review of 1885 FNA cases using the National Cancer Institute-supported recommendations on the uniform approach to breast FNA

BACKGROUND

A probabilistic approach to the classification of fine-needle aspirates (FNAs) of the breast recently was recommended and received endorsement from the National Cancer Institute (NCI). In this system, FNAs are classified as benign, indeterminate/atypical, suspicious/probably malignant, and malignant, but to the authors' knowledge the use of these diagnostic categories has not been evaluated on a large scale. Furthermore, this classification scheme has not been applied to FNAs of nonpalpable lesions of the breast obtained under imaging guidance. Thus, the current study focused on whether the diagnostic categories could be applied usefully to ultrasound-guided FNAs (US-FNAs) of nonpalpable breast lesions.

METHODS

Between 1988-1996, 1885 US-FNAs were performed on 1639 patients. The original FNA diagnoses were reclassified into the NCI-supported recommendations for diagnostic categories of breast FNAs. The cytologic findings were correlated with the tissue specimens, which were available in 851 cases, or with clinical follow-up of a minimum of 2 years in 127 of the 274 patients with benign solid lesions.

RESULTS

The 1885 cases were categorized as follows: 1057 (56.1%) as benign, 86 (4.6%) as atypical, 79 (4.2%) as probably malignant, 502 (26.6%) as malignant, and 161 (8.5%) as unsatisfactory (defined as < 6 epithelial cell groups on all slides). The benign US-FNAs included 480 (45.4%) cysts and 577 (54.6%) solid lesions. Combined clinical and surgical follow-up showed that the frequency of malignancy was 3.7% in US-FNAs classified as benign, 52.9% in those designated as atypical, 75.8% in those designated as suspicious, and 98.9% in those classified as malignant. Based on combined histologic and clinical follow-up, a sensitivity of 97.1% and specificity of 99.1% were found for US-FNAs when definitive benign and malignant diagnoses were considered. A false-negative rate of 3.7% was attributed to sampling error. A false-positive rate of 0.68% was secondary to interpretative error of proliferative lesions.

CONCLUSIONS

Application of the NCI-supported diagnostic categories to US-FNA of nonpalpable breast lesions is useful in stratifying aspirates based on the likelihood of underlying malignancy. The subcategories of US-FNAs diagnosed as atypical have similar probabilities of malignancy; this justifies their being grouped as a single category wherein tissue biopsy would be required to exclude carcinoma. Benign and inadequate FNA diagnoses must be correlated with the clinical and imaging findings and in noncorrelative cases the patient should undergo biopsy. US-FNA is a sensitive and specific means with which to diagnose nonpalpable breast lesions.

Giant pseudocyst formation associated with chronic corneal edema

A 39-year-old man with a 3-week history of an enlarging mass protruding from his right cornea is presented. Clinical and pathologic findings were compatible with a large corneal pseudocyst. Causes of corneal cyst and pseudocyst formation, as well as a proposed mechanism for the giant pseudocyst formation presented here, are discussed.

Assessment of MYCN amplification in neuroblastoma biopsies by differential polymerase chain reaction

Amplification of the oncogene MYCN is a genetic change frequently observed in neuroblastoma and is an indicator of poor prognosis. MYCN copy number is currently determined by Southern blot hybridization. This technique takes 2 to 3 weeks, is labor-intensive, is sensitive to DNA degradation, and requires large quantities of DNA. We have evaluated a new, semiquantitative method of estimating gene copy number that uses differential polymerase chain reaction (PCR). The procedure can be performed in 1 day, is highly reproducible, and requires only nanogram quantities of DNA. It employs a semiquantitative, nonisotopic PCR technique based on differential competition for PCR substrates. MYCN gene primers are amplified together with primers from a single-copy internal control gene. Following electrophoretic separation, the ratio of the two PCR products is determined visually and by densitometric analysis of ethidium bromide-stained agarose gels. This differential ratio is then compared to a series of ratios generated from standards of known MYCN gene copy number. We compared the results obtained by this differential PCR method with those obtained by conventional Southern blotting in 16 cases of primary neuroblastoma. All amplified tumors were detected by differential PCR, and no false positives were observed. We confirmed that differential PCR is a rapid and reliable alternative to Southern blotting for MYCN copy number assessment and is highly suited to the analysis of DNA derived from needle biopsies.