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Malignant biliary stenosis: conventional cytology versus DNA image cytometry

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Abstract

Background

The aim of this study is to evaluate the utility of image cytometry (ICM)-DNA analysis on cytological brush specimens in improving the sensitivity and diagnostic accuracy for biliary neoplasias.

Methods

A total of 71 patients with 89 samples of biliary tree brushing from a stenosis were included in this prospective study. Conventional cytology (CC) and DNA ploidy using ICM of the brushing were performed. Benign or malignant findings were confirmed by surgical exploration or a clinical follow-up of at least 12 months.

Results

Diagnosis was confirmed by clinical follow-up in 44 cases and surgical investigation or histology in 41 cases. A definitive diagnosis of the smears resulted in 40 malignant and 49 benign diagnoses. The sensitivity was 0.666 for CC and 0.658 for ICM, and the specificity was 0.920 and 0.937, respectively. The positive predictive value (PPV) was 0.866 for CC and 0.900 for ICM. McNemar’s test did not reveal a significant difference between CC and ICM (P = 0.803). Agreement of the two methods was found in 73 samples, raising specificity to 0.998 but not sensitivity (0.725).

Conclusions

ICM-DNA seems not to improve significantly the PPV and NPV for detecting neoplasias of the biliary tract compared to CC. Nevertheless a clinical advantage can be seen in the agreement of the two methods in diagnosing dysplasia or cancer, since it did not show false positive results.

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Abbreviations

CC:

Conventional cytology

ICM:

DNA-image-cytometry

NPV:

Negative predictive value

PPV:

Positive predictive value

PSC:

Primary sclerosing cholangitis

SL:

Stem line

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Disclosures

Janek Binek, Nadja Lindenmann, Christa M. Meyenberger, Margarete Hell, Hanno Ulmer, Peter Spieler, and Jan Borovicka have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Gastroenterology Unit, Department of Internal Medicine, Kantonsspital, 9007, St. Gallen, Switzerland

    Janek Binek, Nadja Lindenmann, Christa M. Meyenberger & Jan Borovicka

  2. Institute of Pathology, Kantonsspital, 9007, St. Gallen, Switzerland

    Margarete Hell & Peter Spieler

  3. Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, 6020, Innsbruck, Austria

    Hanno Ulmer

Authors
  1. Janek Binek
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  2. Nadja Lindenmann
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  3. Christa M. Meyenberger
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  4. Margarete Hell
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  5. Hanno Ulmer
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  6. Peter Spieler
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  7. Jan Borovicka
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Correspondence to Janek Binek.

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Binek, J., Lindenmann, N., Meyenberger, C.M. et al. Malignant biliary stenosis: conventional cytology versus DNA image cytometry. Surg Endosc 25, 1808–1813 (2011). https://doi.org/10.1007/s00464-010-1469-0

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  • DOI: https://doi.org/10.1007/s00464-010-1469-0

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