title: Preliminary experience comparing routine cytology results with the composite results of digital image analysis and fluorescence in situ hybridization in patients undergoing EUS-guided FNA.
abstract: BACKGROUND
  Studies indicate enhanced diagnostic accuracy for digital image analysis (DIA) and fluorescence in situ hybridization (FISH) versus routine cytology examination (RC) when biliary strictures are evaluated. These tumor markers have not been applied to EUS-guided FNA.
  
  
  OBJECTIVE
  Our purpose was to determine the accuracy of RC versus the composite results of DIA/FISH.
  
  
  METHODS
  Patients enrolled with known or suspected malignancy. The final diagnosis was based on strict cytopathologic and imaging criteria and 12-month follow-up.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A total of 39 patients were enrolled in whom each diagnostic test was performed on samples from 42 sites to evaluate lymphadenopathy (n=19), pancreatic mass (n=19), esophageal or gastric wall mass (n=3), and thyroid mass (n=1).
  
  
  METHODS
  EUS-guided FNA with RC, DIA, and FISH.
  
  
  METHODS
  Diagnostic accuracy of RC, DIA, and FISH.
  
  
  RESULTS
  Malignancy was diagnosed in 30 of 42 patients, including esophageal squamous cell carcinoma, esophageal adenocarcinoma, gastric adenocarcinoma, pancreatic adenocarcinoma, pancreatic mucinous cystic neoplasia, intraductal papillary mucinous neoplasia, metastatic forearm sarcoma, small cell and non-small cell lung cancer, thyroid carcinoma, malignant GI stromal tumor, melanoma, adenocarcinoma of unknown primary, and lymphoma. The sensitivity, specificity, and accuracy of DIA/FISH versus RC for detecting malignancy were 97%, 100%, and 98% versus 87%, 100%, and 90%, respectively.
  
  
  CONCLUSIONS
  Single-center pilot study.
  
  
  CONCLUSIONS
  Our findings suggest that DIA and FISH processing of EUS-guided FNA specimens provides higher diagnostic accuracy than RC does. These data suggest that these tumor markers incorporate generic targets as suggested by the high diagnostic sensitivity in this patient cohort with diverse pathologic conditions.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Clain
authors.forename: Amy
authors.initials: A
authors.lastname: Clayton
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Halling
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Kipp
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rajan
authors.forename: Lewis R
authors.initials: LR
authors.lastname: Roberts
authors.forename: Renee M
authors.initials: RM
authors.lastname: Root
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Sebo
authors.forename: Mark D
authors.initials: MD
authors.lastname: Topazian
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.forename: Maurits J
authors.initials: MJ
authors.lastname: Wiersema
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gores
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D015331:Cohort Studies; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000473:pathology*; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D017404:In Situ Hybridization, Fluorescence; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000473:pathology*; D010865:Pilot Projects; D012680:Sensitivity and Specificity; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000473:pathology*