title: Fluorescence in situ hybridization as adjunct to cytology improves the diagnosis and directs estimation of prognosis of malignant pleural effusions.
abstract: BACKGROUND
  The identification of malignant cells in effusions by conventional cytology is hampered by its limited sensitivity and specificity. The aim of this study was to investigate the value of fluorescence in situ hybridization (FISH) as adjuncts to conventional cytologic examination in patients with malignant pleural effusions.
  
  
  METHODS
  We conducted a retrospective cohort study of 93 inpatients with pleural effusions (72 malignant pleural effusions metastatic from 11 different organs and 21 benign) over 23 months. All the patients came from Chinese northeast areas. Aspirated pleural fluid underwent cytologic examination and fluorescence in situ hybridization (FISH) for aneuploidy. We used FISH in single-colour or if appropriate in dual-colour evaluation to detect chromosomal aberrations (chromosomes 7, 11, and 17) in effusion cells as markers of malignancy, to raise the diagnostic yield and identified the efficiency by diagnostic biopsy. Predominant cytogenetic anomalies and patterns of intratumor cytogenetic heterogeneity were brought in relation to overall survival rate.
  
  
  RESULTS
  Cytology alone confirmed malignant pleural effusions in 45 of 72 patients (sensitivity 63%), whereas FISH alone positively identified 48 of 72 patients (sensitivity 67%). Both tests had high specificity in predicting benign effusions. If cytology and FISH were considered together, they exhibited 88% sensitivity and 94.5% specificity in discriminating benign and malignant effusions. Combined, the two assays were more sensitive than either test alone. Although the positive predictive value of each test was 94.5%, the negative predictive value of cytology and FISH combined was 78%, better than 47% and 44% for FISH and cytology alone, respectively. There was a significantly prolonged survival rate for patients with aneuploidy for chromosome 17.
  
  
  CONCLUSIONS
  FISH in combination with conventional cytology is a highly sensitive and specific diagnostic tool for detecting malignant cells in pleural effusions . The high sensitivity and specificity may be associated with geographic area and race. Simple numeric FISH anomalies may be prognostic.
authors.affiliation: Department of Thoracic Surgery, The Fourth Affiliated Hospital, Harbin Medical University, Nan gang District, Harbin, Heilongjiang Province 150001, China.
authors.forename: Jingquan
authors.initials: J
authors.lastname: Han
authors.forename: Shouqiang
authors.initials: S
authors.lastname: Cao
authors.forename: Kai
authors.initials: K
authors.lastname: Zhang
authors.forename: Guibin
authors.initials: G
authors.lastname: Zhao
authors.forename: Yanzhong
authors.initials: Y
authors.lastname: Xin
authors.forename: Qing
authors.initials: Q
authors.lastname: Dong
authors.forename: Yubo
authors.initials: Y
authors.lastname: Yan
authors.forename: Jian
authors.initials: J
authors.lastname: Cui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002877:Chromosomes, Human; D015331:Cohort Studies; D005122:Exudates and Transudates / Q000737:chemistry / Q000166:cytology; D005260:Female; D006651:Histocytochemistry / Q000379:methods*; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity