A Multivariable Model Using Advanced Cytologic Methods for the Evaluation of Indeterminate Pancreatobiliary Strictures

Fritcher, Emily G. Barr; Kipp, Benjamin R.; Halling, Kevin C.; Oberg, Trynda N.; Bryant, Sandra C.; Tarrell, Robert F.; Gores, Gregory J.; Levy, Michael J.; Clayton, Amy C.; Sebo, Thomas J.; Roberts, Lewis R.

doi:10.1053/j.gastro.2009.02.040

Cited by 174 publications

(156 citation statements)

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“…2 Equivocal FISH results (trisomy 7) were considered negative for statistical analyses. All P values were calculated using a two-tailed Fisher's Exact test with JMP 8.0 statistical software (SAS Institute Inc., Cary, NC).…”

Section: Statisticsmentioning

confidence: 99%

“…The ages of patients included in this study ranged from 15 to 87 years, with a mean and median age of 59 and 60 years, respectively. Specimens were selected from a larger study 2 by first subcategorizing patients based on the combination of their FISH and clinicopathology follow-up results. Specimens were included from each of the predetermined categorizations based on whether there was adequate (visible) residual cell pellet available for KRAS testing.…”

Section: Patient Specimensmentioning

confidence: 99%

“…A large clinical study recently demonstrated that FISH was more sensitive than cytology for detecting pancreatobiliary tract cancer. 2 FISH was able to detect 49/227 (22%) cancers that routine cytology interpreted as nonmalignant without compromising test specificity. However, the overall sensitivity of polysomy FISH (43%) was only moderate.…”

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confidence: 99%

“…However, the inclusion of trisomy 7 as a criterion for a positive result significantly increases the false positive rate of FISH because only ϳ50% of patients with trisomy 7 results have cancer on clinicopathologic follow-up. 2 Consequently, although detection rates are improved by FISH testing, additional or substitute molecular markers are needed to further improve the detection of pancreatobiliary tract cancer.…”

mentioning

confidence: 99%

“…Biliary brushing cytology, although highly specific, has suffered from low to moderate sensitivity (15%Ϫ68%). [2][3][4][5][6] As a result, ancillary diagnostic techniques including mutation analysis, [7][8][9][10][11] DNA ploidy analysis, 12,13 methylation analysis, 14 -17 and fluorescence in situ hybridization (FISH), 2,4,18,19 have been studied to improve tumor detection.…”

mentioning

confidence: 99%

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Comparison of KRAS Mutation Analysis and FISH for Detecting Pancreatobiliary Tract Cancer in Cytology Specimens Collected During Endoscopic Retrograde Cholangiopancreatography

Kipp

Fritcher

Clayton

et al. 2010

The Journal of Molecular Diagnostics

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Pancreatobiliary tract strictures result either from malignancies of the biliary tract and pancreas or from nonmalignant etiopathogenesis. The goal of this study was to determine whether KRAS mutations could be identified in residual pancreatobiliary stricture brushings and to compare the performance characteristics of KRAS mutation analysis to cytology and fluorescence in situ hybridization (FISH) for the detection of carcinoma. Residual brushing cytology cell pellets were retrieved from 132 patients with subsequent clinicopathologic follow-up of cholangiocarcinoma (n ‫؍‬ 41), pancreatic adenocarcinoma (n ‫؍‬ 35), gallbladder cancer (n ‫؍‬ 2), and nonmalignant strictures (n ‫؍‬ 54). All specimens had a prior cytology and FISH UroVysion results as part of clinical practice. KRAS mutation analysis was performed using the quantitative PCR DxS KRAS Mutation Test Kit. KRAS mutation analysis was successful in 130 of 132 specimens. KRAS mutations and polysomic (ie, positive) FISH results were identified in 24 (69%) and 22 (63%) pancreatic adenocarcinoma specimens, respectively, with a combined sensitivity of 86% (30/35). KRAS mutations and polysomic FISH results were identified in 12 (29%) and 17 (41%) cholangiocarcinoma specimens, with a combined sensitivity of 54% (22/41). KRAS mutations were identified in two patients with primary sclerosing cholangitis, and benign follow-up. Residual cytology specimens can be used to detect KRAS mutations by quantitative PCR. Combined KRAS mutation and FISH analysis appear to increase the cancer detection rate in patients with pancreatobiliary strictures.

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Section: Statisticsmentioning

confidence: 99%

Section: Patient Specimensmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%