PMID- 30106834
OWN - NLM
STAT- MEDLINE
DCOM- 20200929
LR  - 20200929
IS  - 1539-2031 (Electronic)
IS  - 0192-0790 (Print)
IS  - 0192-0790 (Linking)
VI  - 53
IP  - 9
DP  - 2019 Oct
TI  - The Diagnostic Yield of Malignancy Comparing Cytology, FISH, and Molecular 
      Analysis of Cell Free Cytology Brush Supernatant in Patients With Biliary 
      Strictures Undergoing Endoscopic Retrograde Cholangiography (ERC): A Prospective 
      Study.
PG  - 686-692
LID - 10.1097/MCG.0000000000001118 [doi]
AB  - BACKGROUND: Routine cytology of biliary stricture brushings obtained during 
      endoscopic retrograde cholangiopancreatography (ERCP) has suboptimal sensitivity 
      for malignancy. We compared the individual and combined ability of cytology, 
      fluorescence in situ hybridization (FISH) analysis and PCR-based mutation 
      profiling (MP) to detect malignancy in standard biliary brushings. METHODS: We 
      performed a prospective study of patients undergoing ERCP using histology or 1 
      year follow-up to determine patient outcomes. MP was performed on free-DNA from 
      biliary brushing specimens using normally discarded supernatant fluid. MP 
      examined KRAS point mutations and tumor suppressor gene associated loss of 
      heterozygosity mutations at 10 genomic loci. FISH examined chromosome specific 
      gains or losses. RESULTS: A total of 101 patients were included in final analysis 
      and 69% had malignancy. Cytology had 26% sensitivity and 100% specificity for 
      malignancy. Using either FISH or MP in combination with cytology increased 
      sensitivity to 44% and 56%, respectively. The combination of all 3 tests 
      (cytology, FISH, and MP) had the highest sensitivity for malignancy (66%). There 
      was no difference in the specificity of cytology, FISH or MP testing when 
      examined alone or in combination. MP improved diagnostic yield of each procedure 
      from 22% to 100%; FISH improved yield to 90%. MP detected 21 malignancies beyond 
      that identified by cytology; FISH detected an additional 13. The combination of 
      FISH and MP testing detected an additional 28 malignancies. CONCLUSIONS: Both MP 
      and FISH are complimentary molecular tests that can significantly increase 
      detection of biliary malignancies when used in combination with routine cytology 
      of standard biliary brush specimens.
FAU - Kushnir, Vladimir M
AU  - Kushnir VM
AD  - Department of Medicine, Division of Gastroenterology, Washington University 
      School of Medicine, St Louis, MO.
FAU - Mullady, Daniel K
AU  - Mullady DK
AD  - Department of Medicine, Division of Gastroenterology, Washington University 
      School of Medicine, St Louis, MO.
FAU - Das, Koushik
AU  - Das K
AD  - Department of Medicine, Division of Gastroenterology, Washington University 
      School of Medicine, St Louis, MO.
FAU - Lang, Gabriel
AU  - Lang G
AD  - Department of Medicine, Division of Gastroenterology, Washington University 
      School of Medicine, St Louis, MO.
FAU - Hollander, Thomas G
AU  - Hollander TG
AD  - Department of Medicine, Division of Gastroenterology, Washington University 
      School of Medicine, St Louis, MO.
FAU - Murad, Faris M
AU  - Murad FM
AD  - Department of Medicine, Division of Gastroenterology, Washington University 
      School of Medicine, St Louis, MO.
FAU - Jackson, Sara A
AU  - Jackson SA
AD  - Interpace Diagnostics Corporation, Pittsburgh, PA.
FAU - Toney, Nicole A
AU  - Toney NA
AD  - Interpace Diagnostics Corporation, Pittsburgh, PA.
FAU - Finkelstein, Sydney D
AU  - Finkelstein SD
AD  - Interpace Diagnostics Corporation, Pittsburgh, PA.
FAU - Edmundowicz, Steven A
AU  - Edmundowicz SA
AD  - Department of Medicine, Division of Gastroenterology, Washington University 
      School of Medicine, St Louis, MO.
AD  - Department of Medicine, Division of Gastroenterology, University of Colorado 
      Medical Center, Denver, CO.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - J Clin Gastroenterol
JT  - Journal of clinical gastroenterology
JID - 7910017
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Biliary Tract Neoplasms/*diagnosis/genetics
MH  - Cell-Free System
MH  - *Cholangiopancreatography, Endoscopic Retrograde
MH  - Cholestasis/*diagnosis
MH  - Cytodiagnosis
MH  - Female
MH  - Humans
MH  - In Situ Hybridization, Fluorescence
MH  - Male
MH  - Middle Aged
MH  - Mutation
MH  - Polymerase Chain Reaction
MH  - Prospective Studies
MH  - Sensitivity and Specificity
PMC - PMC6768606
EDAT- 2018/08/15 06:00
MHDA- 2020/09/30 06:00
PMCR- 2019/09/30
CRDT- 2018/08/15 06:00
PHST- 2018/08/15 06:00 [pubmed]
PHST- 2020/09/30 06:00 [medline]
PHST- 2018/08/15 06:00 [entrez]
PHST- 2019/09/30 00:00 [pmc-release]
AID - 10.1097/MCG.0000000000001118 [doi]
PST - ppublish
SO  - J Clin Gastroenterol. 2019 Oct;53(9):686-692. doi: 10.1097/MCG.0000000000001118.