PMID- 19232347
OWN - NLM
STAT- MEDLINE
DCOM- 20090708
LR  - 20220408
IS  - 1528-0012 (Electronic)
IS  - 0016-5085 (Linking)
VI  - 136
IP  - 7
DP  - 2009 Jun
TI  - A multivariable model using advanced cytologic methods for the evaluation of 
      indeterminate pancreatobiliary strictures.
PG  - 2180-6
LID - 10.1053/j.gastro.2009.02.040 [doi]
AB  - BACKGROUND & AIMS: Ancillary cytologic tests including digital image analysis 
      (DIA) and fluorescence in situ hybridization (FISH) have been developed to 
      improve the sensitivity of routine cytology (RC) for the diagnosis of malignancy 
      in pancreatobiliary strictures. The goal of this study was to retrospectively 
      compare the performance of RC, DIA, and FISH on clinical brushing specimens. 
      METHODS: Endoscopic retrograde cholangiopancreatography brushings were obtained 
      from 498 consecutive patients with pancreatobiliary strictures and analyzed by 
      RC, DIA, and FISH as per standard practice. RC diagnostic categories included 
      negative, atypical, suspicious, or positive. Aneuploid/tetraploid histograms were 
      considered positive for DIA. FISH was performed using UroVysion (Abbott 
      Molecular, Inc, Des Plaines, IL) and classified as negative, trisomy, tetrasomy, 
      or polysomy. RESULTS: The sensitivity of polysomy FISH (42.9%) was significantly 
      higher than RC (20.1%) when equivocal RC results were considered negative (P < 
      .001) with identical specificity (99.6%). There was a significant difference in 
      time for diagnosis of carcinoma between FISH diagnostic categories (P < .001) and 
      between RC diagnostic categories (P < .001). Logistic regression analysis 
      revealed that polysomy FISH, trisomy FISH, suspicious cytology, primary 
      sclerosing cholangitis status, and age were associated with carcinoma (P < .05). 
      CONCLUSIONS: Polysomy FISH had high sensitivity without compromise to 
      specificity. DIA was not a significant independent predictor of malignancy. 
      Multivariable modeling using RC, FISH, age, and primary sclerosing cholangitis 
      status can be used to estimate the probability of carcinoma for an individual 
      patient. We recommend including FISH as a routine test where available, along 
      with RC, in the evaluation of indeterminate pancreatobiliary strictures.
FAU - Fritcher, Emily G Barr
AU  - Fritcher EG
AD  - Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, 
      Rochester, Minnesota 55905, USA.
FAU - Kipp, Benjamin R
AU  - Kipp BR
FAU - Halling, Kevin C
AU  - Halling KC
FAU - Oberg, Trynda N
AU  - Oberg TN
FAU - Bryant, Sandra C
AU  - Bryant SC
FAU - Tarrell, Robert F
AU  - Tarrell RF
FAU - Gores, Gregory J
AU  - Gores GJ
FAU - Levy, Michael J
AU  - Levy MJ
FAU - Clayton, Amy C
AU  - Clayton AC
FAU - Sebo, Thomas J
AU  - Sebo TJ
FAU - Roberts, Lewis R
AU  - Roberts LR
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
DEP - 20090214
PL  - United States
TA  - Gastroenterology
JT  - Gastroenterology
JID - 0374630
SB  - IM
MH  - Aged
MH  - Biopsy, Needle
MH  - Cholangiopancreatography, Endoscopic Retrograde
MH  - Cholestasis, Extrahepatic/complications/*pathology
MH  - Constriction, Pathologic
MH  - *Cytodiagnosis
MH  - *Diagnosis, Computer-Assisted
MH  - Female
MH  - Humans
MH  - Immunohistochemistry
MH  - *In Situ Hybridization, Fluorescence
MH  - Kaplan-Meier Estimate
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Pancreatic Neoplasms/complications/*pathology
MH  - Probability
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
EDAT- 2009/02/24 09:00
MHDA- 2009/07/09 09:00
CRDT- 2009/02/24 09:00
PHST- 2008/10/02 00:00 [received]
PHST- 2009/01/14 00:00 [revised]
PHST- 2009/02/02 00:00 [accepted]
PHST- 2009/02/24 09:00 [entrez]
PHST- 2009/02/24 09:00 [pubmed]
PHST- 2009/07/09 09:00 [medline]
AID - S0016-5085(09)00284-4 [pii]
AID - 10.1053/j.gastro.2009.02.040 [doi]
PST - ppublish
SO  - Gastroenterology. 2009 Jun;136(7):2180-6. doi: 10.1053/j.gastro.2009.02.040. Epub 
      2009 Feb 14.