Polysomy and p16 deletion by fluorescence in situ hybridization in the diagnosis of indeterminate biliary strictures
Polysomy and p16 deletion by fluorescence in situ hybridization in the diagnosis of indeterminate biliary strictures
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DOI：
10.1016/j.gie.2011.08.022
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发表时间：
2012-01-01
影响因子：
7.7
通讯作者：
Stevens, Peter D.
中科院分区：
文献类型：
--
作者：
Gonda, Tamas A.;Glick, Michael P.;Stevens, Peter D.
背景：由于细胞学的敏感性低，无法确定的胆管狭窄的诊断是有限的。然而，恶性肿瘤的准确诊断是至关重要的，在疑似胆道恶性肿瘤患者的管理。通过荧光原位杂交（FISH）检测染色体非整倍体可能会增加产量。目的：评估FISH在不确定的胆管狭窄中的诊断准确性，以及在恶性胆管狭窄的诊断标准中包括9 p21（p16）缺失的额外价值。设计：回顾性综述。设置：学术医学中心。患者：本研究涉及76名连续患者，他们在我们机构接受了不确定狭窄的评价。对这些患者进行了筛选，50名最终病理诊断或随访时间>= 12个月的患者被纳入分析。主要结果测量：单独细胞学与FISH多体性与FISH多体性和9 p21缺失的灵敏度、特异性和曲线下面积（AUC）分析比较。FISH检测发现3号、7号或17号染色体拷贝数增加（多体性），刷检细胞学的敏感性从21%增加到58%，当包括9 p21缺失时，敏感性增加到89%。FISH的特异性为97%（细胞学为100%）。细胞学联合FISH多体性（AUC = 0.93）或p16缺失的准确性显著高于单独细胞学（AUC 0.6; P <0.001）或甚至细胞学联合FISH多体性（AUC = 0.77; P <0.001）。
Background: The diagnosis of indeterminate biliary strictures is limited because of the low sensitivity of cytology. However, an accurate diagnosis of malignancy is critical in the management of patients with suspected biliary malignancy. Testing for chromosomal aneuploidy by fluorescence in situ hybridization (FISH) may increase the yield.Objective: To evaluate the diagnostic accuracy of FISH in indeterminate biliary strictures and the additional value of including deletion of 9p21 (p16) in the diagnostic criteria of malignant biliary strictures.Design: Retrospective review.Setting: Academic medical center.Patients: This study involved 76 consecutive patients who were seen for the evaluation of indeterminate strictures at our institution. These patients were screened, and 50 patients with either a final pathologic diagnosis or >= 12 months' conclusive follow-up were included in the analysis.Main Outcome Measurements: Sensitivity, specificity, and area under the curve (AUC) analysis of cytology alone compared with the presence of FISH polysomy versus FISH polysomy and 9p21 deletion.Results: The presence of increased copy numbers (polysomy) of chromosome 3, 7, or 17 by FISH increased the sensitivity of brush cytology from 21% to 58%, and when the presence of 9p21 deletion was included, the sensitivity increased to 89%. The specificity of FISH was 97% (vs 100% for cytology). The accuracy of cytology combined with FISH polysomy (AUC = 0.93) or p16 deletion was significantly greater than the accuracy of cytology alone (AUC 0.6; P < .001) or even cytology combined with FISH polysomy (AUC = 0.77; P