A prospective comparison of digital image analysis and routine cytology for the identification of malignancy in biliary tract strictures.
OBJECTIVE
Digital image analysis (DIA) allows quantification of nuclear DNA content and may help distinguish benign and malignant strictures of the biliary tract.


METHODS
One hundred ten consecutive patients undergoing endoscopic retrograde cholangiography for suspicious biliary tract strictures were enrolled in a prospective study comparing the accuracy of DIA and routine cytology (RC). Standard brush cytology sampling was performed twice by using 2 cytology brushes per patient. Both brushes were fixed in a single-specimen vial. Each specimen was formed into 1 pellet, and the sample was equally divided for evaluation by DIA and RC. DNA histograms were generated for ploidy analysis. The DIA criterion for malignancy was demonstration of aneuploidy.


RESULTS
Two patients had inadequate samples obtained for DIA analysis, 7 benign patients were excluded because of inadequate follow-up of less than 75 days, and 1 patient was lost to follow-up to clarify malignant versus benign disease. Of the remaining 100 patients, 56 strictures were malignant and 44 were benign. The sensitivities of DIA and RC were 39.3% and 17.9%, respectively (P = 0.014). The specificities of DIA and RC were 77.3% and 97.7%, respectively (P = 0.003). The accuracy of DIA (56.0%) was equivalent to RC (53.0%).


CONCLUSIONS
DIA is a valuable adjunct to RC for detecting malignant strictures of the biliary tract.
Baron
Todd H
TH
Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota 55905, USA. baron.todd@mayo.edu
Harewood
Gavin C
GC
Rumalla
Ashwin
A
Pochron
Nicole L
NL
Stadheim
Linda M
LM
Gores
Gregory J
GJ
Therneau
Terry M
TM
De Groen
Piet C
PC
Sebo
Thomas J
TJ
Salomao
Diva R
DR
Kipp
Benjamin R
BR
D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000473:pathology; D001661:Biliary Tract Neoplasms / Q000473:pathology*; D001707:Biopsy, Needle; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D003581:Cytodiagnosis; D004273:DNA, Neoplasm / Q000032:analysis; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted
D004273:DNA, Neoplasm