title: Fluorescence in situ hybridization for diagnosis of cholangiocarcinoma in primary sclerosing cholangitis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Patients with primary sclerosing cholangitis (PSC) are at risk of developing cholangiocarcinoma (CCA). Fluorescence in situ hybridization (FISH) may aid diagnosis of CCA.
  
  
  OBJECTIVE
  To determine the diagnostic utility of FISH for CCA detection in patients with PSC.
  
  
  METHODS
  Meta-analysis.
  
  
  METHODS
  Tertiary-care medical center.
  
  
  METHODS
  Patients in studies where histopathologic correlation of CCA was available; 2 × 2 contingency data were constructed.
  
  
  METHODS
  Database search and review of study findings.
  
  
  METHODS
  Sensitivity, specificity, likelihood ratio, and pooled diagnostic odds ratio.
  
  
  RESULTS
  The search yielded 8 studies, involving 828 patients who could be included in our meta-analysis. The pooled sensitivity and specificity of FISH for diagnosis of CCA in patients with PSC were 68% (95% confidence interval [CI], 61%-74%) and 70% (95% CI, 66%-73%), respectively. The pooled positive likelihood ratio was 2.69 (95% CI, 1.84-3.97), and the negative likelihood ratio was 0.47 (95% CI, 0.39-0.58). The pooled diagnostic odds ratio was 7.24 (95% CI, 3.93-13.36). For FISH polysomy (6 studies, n = 690), the pooled sensitivity and specificity of FISH were 51% (95% CI, 43%-59%) and 93% (95% CI, 91%-95%), respectively. The heterogeneity indices of I(2) measure of inconsistency was 45.9%. Visual inspection of the funnel plot showed low potential for publication bias.
  
  
  CONCLUSIONS
  Inclusion of low-quality studies.
  
  
  CONCLUSIONS
  Our study suggests that FISH polysomy is highly specific; however, limited sensitivity of FISH highlights that better markers are required for early detection of CCA in PSC.
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.
authors.forename: Basile
authors.initials: B
authors.lastname: Njei
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Preethi G K
authors.initials: PG
authors.lastname: Venkatesh
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
mesh_terms: D001650:Bile Duct Neoplasms / Q000175:diagnosis*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000175:diagnosis*; D015209:Cholangitis, Sclerosing / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods*; D015203:Reproducibility of Results