dvanced Cytologic Techniques for the Detection of Malignant Pancreatobiliary

e i ackground & Aims: Two advanced cytologic techniques or detecting aneuploidy— digital image analysis (DIA) and flurescence in situ hybridization (FISH)— have recently been deeloped to help identify malignant pancreatobiliary strictures. he aim of this study was to assess the clinical utility of ytology, DIA, and FISH for the identification of malignant ancreatobiliary strictures. Methods: Brush cytologic speciens from 233 consecutive patients undergoing endoscopic etrograde cholangiopancreatography for pancreatobiliary stricures were examined by all 3 (cytology, DIA, and FISH) techiques. Strictures were stratified as proximal (n 33) or distal n 114) based on whether they occurred above or below the ystic duct, respectively. Strictures in patients with primary clerosing cholangitis (n 86) were analyzed separately. esults: Despite the stratification, the performances of the ests were similar. Conventional cytology has a low sensitivity 4%–20%) but 100% specificity. Because of the high specificity or cytology, we assessed the performance of the other tests hen conventional cytology was negative. In this clinical conext, FISH had an increased sensitivity (35%– 60%) when assessng for chromosomal gains (polysomy) while preserving the pecificity of cytology. The sensitivity and specificity of DIA was ntermediate as compared with routine cytology and FISH but as additive to FISH values demonstrating only trisomy of hromosome 7 or chromosome 3. Conclusions: These findngs suggest that FISH and DIA increase the sensitivity for the iagnosis of malignant pancreatobiliary tract strictures over hat obtained by conventional cytology while maintaining an cceptable specificity.