Advanced cytologic techniques for the detection of malignant pancreatobiliary strictures
Advanced cytologic techniques for the detection of malignant pancreatobiliary strictures
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DOI：
10.1053/j.gastro.2006.08.021
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发表时间：
2006-10-01
期刊：
影响因子：
29.4
通讯作者：
Gores, Gregory J.
中科院分区：
文献类型：
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作者：
Luna, Laura E. Moreno;Kipp, Benjamin;Gores, Gregory J.
背景与目的：两种先进的检测非整倍体的细胞学技术-数字图像分析（DIA）和荧光原位杂交(FISH)-最近被开发用于帮助识别恶性胰胆管狭窄。本研究的目的是评估细胞学、DIA和FISH在鉴别恶性胰胆管狭窄中的临床应用。方法：对233例连续行内窥镜逆行胆管造影治疗胰胆管狭窄患者的刷细胞学标本进行3种技术（细胞学、DIA和FISH）检查。根据狭窄是否发生在囊管上方或下方，分别将其分为近端（n = 33）或远端（n = 114）。对原发性硬化性胆管炎患者狭窄情况（86例）进行单独分析。结果：尽管分层，但测试的性能是相似的。常规细胞学敏感性低（4%-20%），但特异性为100%。由于细胞学的高特异性，当常规细胞学结果为阴性时，我们评估了其他测试的表现。在这种临床背景下，FISH在评估染色体增益（多体）时具有更高的敏感性（35%-60%），同时保留了细胞学的特异性。与常规细胞学和FISH相比，DIA的敏感性和特异性处于中等水平，但与FISH值相加仅显示7号染色体或3号染色体三体。结论：这些结果表明，FISH和DIA比常规细胞学诊断恶性胰胆道狭窄的敏感性更高，同时保持了可接受的特异性。
Background & Aims: Two advanced cytologic techniques for detecting aneuploidy-digital image analysis (DIA) and fluorescence in situ hybridization (FISH)-have recently been developed to help identify malignant pancreatobiliary strictures. The aim of this study was to assess the clinical utility of cytology, DIA, and FISH for the identification of malignant pancreatobiliary strictures. Methods: Brush cytologic specimens from 233 consecutive patients undergoing endoscopic retrograde cholangiopancreatography for pancreatobiliary strictures were examined by all 3 (cytology, DIA, and FISH) techniques. Strictures were stratified as proximal (n = 33) or distal (n = 114) based on whether they occurred above or below the cystic duct, respectively. Strictures in patients with primary sclerosing cholangitis (n = 86) were analyzed separately. Results: Despite the stratification, the performances of the tests were similar. Conventional cytology has a low sensitivity (4%-20%) but 100% specificity. Because of the high specificity for cytology, we assessed the performance of the other tests when conventional cytology was negative. in this clinical context, FISH had an increased sensitivity (35%-60%) when assessing for chromosomal gains (polysomy) while preserving the specificity of cytology. The sensitivity and specificity of DIA was intermediate as compared with routine cytology and FISH but was additive to FISH values demonstrating only trisomy of chromosome 7 or chromosome 3. Conclusions: These findings suggest that FISH and DIA increase the sensitivity for the diagnosis of malignant pancreatobiliary tract strictures over that obtained by conventional cytology while maintaining an acceptable specificity.