Prospective Evaluation of Advanced Molecular Markers and Imaging Techniques in Patients With Indeterminate Bile Duct Strictures

Abstract

BACKGROUND AND AIMS-Standard techniques for evaluating bile duct strictures have poor sensitivity for detection of malignancy. Newer imaging modalities, such as intraductal ultrasound (IDUS), and advanced cytologic techniques, such as digital image analysis (DIA) and fluorescence in situ hybridization (FISH), identify chromosomal abnormalities, and may improve sensitivity while maintaining high specificity. Our aim was to prospectively evaluate the accuracy of these techniques in patients with indeterminate biliary strictures.

Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline

“…Serum laboratory tests are neither sensitive nor specific enough to evaluate PSC progression (41), but in case of rapid increase of serum bilirubin levels and/or cholestatic liver enzymes (serum alkaline phosphatase, serum gamma glutamyl transferase) ERCP is indicated (6), especially in patients with a diagnosis of clinically significant hilar or extrahepatic strictures on MRC. Elevation of serum CA19-9 in PSC patients has an unsatisfactory sensitivity (14%) and positive predictive value (67%) for the diagnosis of CCA (36,41,42), and is not helpful in selecting patients for ERCP. c) Progression/new onset clinically significant strictures on MRC.…”

“…Addition of FISH analysis of cytology specimens enhanced the sensitivity for detecting CCA in patients with PSC in several patient series (42,43,102,103 …”

The Utility of UroVysion Fluorescence In Situ Hybridization in Pancreatic Fine-Needle Aspiration Samples Directed and Obtained by Endoscopic Ultrasonography

“…Other authors 9,10 have found that when only polysomic results were considered in biliary brushing or washing specimens, the specificity was 100%. Barr Fritcher et al 11 state that polysomic UFISH finding is indicative of carcinoma in the context of a biliary stricture.…”

“…These findings are similar to results described by other researchers on biliary brushings and washings associated with biliary strictures. [9][10][11][12][13][14] Our patient follow-up studies helped us to look at the true sensitivity and specificity of UFISH as an adjuvant test to FNA. Of the 30 cases with FNA results that were suspicious, reactive, or negative, we feel we were able to definitively classify the condition of 7 patients as benign and of 9 as malignant, on the basis of our hospital medical records.…”

“…Levy et al 10 also studied the use of intraductal ultrasonography (IDUS), DIA, and UFISH in patients with biliary strictures. They examined 86 patients with indeterminate biliary strictures and concluded that DIA, UFISH, and IDUS enhance the accuracy by allowing diagnosis of malignancy in a substantial number of patients with false-negative cytology and histology findings.…”