Image cytometry as a discriminatory tool for cytologic specimens obtained by endoscopic retrograde cholangiopancreatography.
BACKGROUND
Routine brush cytology is relatively insensitive for the diagnosis of biliary and pancreatic malignancy. Sensitivity can be improved by measuring DNA and proliferation. The goal of this study was to assess the discriminatory capacity of image cytometry using pancreaticobiliary brush cytology specimens obtained during endoscopic retrograde cholangiopancreatography (ERCP). Analysis included morphometry, DNA quantification, and characterization of nuclear chromatin distribution and condensation.


METHODS
Brush cytology specimens were obtained during ERCP from 22 chronic pancreatitis specimens, 11 pancreatic adenocarcinoma specimens, 13 primary sclerosing cholangitis specimens, and 11 cholangiocarcinoma specimens and contrasted with 25 normal epithelia specimens. A SAMBA 2005 image processor was used to analyze Feulgen stained chromatin density and distribution. Discriminant analysis of 37 morphonuclear variables was performed to characterize differences between: 1) chronic pancreatitis and pancreatic adenocarcinoma, and 2) primary sclerosing cholangitis and cholangiocarcinoma.


RESULTS
Chronic pancreatitis was distinguished from pancreatic adenocarcinoma (P < or = 0.001); sensitivity and specificity were both estimated to be 82%. Primary sclerosing cholangitis was distinguished from cholangiocarcinoma (P < or = 0.01); sensitivity and specificity were estimated to be 82% and 85%, respectively.


CONCLUSIONS
Multiparameter image cytometry has potential as an adjuvant diagnostic technique in patients with pancreaticobiliary malignancy.
Sears
R J
RJ
Digestive Health Center, University of Virginia Health Sciences Center, Charlottesville 22906-0013, USA.
Duckworth
C W
CW
Decaestecker
C
C
Bourgeois
N
N
Ledent
T
T
Deviere
J
J
Salmon
I
I
Kiss
R
R
Yeaton
P
P
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D001661:Biliary Tract Neoplasms / Q000175:diagnosis* / Q000473:pathology; D001707:Biopsy, Needle; D018281:Cholangiocarcinoma / Q000175:diagnosis* / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000175:diagnosis / Q000473:pathology; D004273:DNA, Neoplasm / Q000032:analysis; D003937:Diagnosis, Differential; D006801:Humans; D019044:Image Cytometry / Q000592:standards*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D010195:Pancreatitis / Q000175:diagnosis / Q000473:pathology; D012680:Sensitivity and Specificity
D004273:DNA, Neoplasm