Comparison of methods to detect neoplasia in patients undergoing endoscopic ultrasound-guided fine-needle aspiration

Michael J. Levy, Trynda N. Oberg, Michael B. Campion, Amy C. Clayton, Kevin C. Halling, Michael R. Henry, Benjamin R. Kipp, Thomas J. Sebo, Jun Zhang, Felicity T Enders, Jonathan E. Clain, Ferga C. Gleeson, Elizabeth Rajan, Lewis Rowland Roberts, Mark Topazian, Kenneth Ke Ning Wang, Gregory James Gores

Research output: Contribution to journalArticle

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Abstract

Background & Aims: Digital image analysis (DIA) and fluorescence in situ hybridization (FISH) can be used to evaluate biliary strictures with greater accuracy than conventional cytology (CC). We performed a prospective evaluation of the accuracy of CC, compared with that of DIA and FISH, in detection of malignancy in patients undergoing endoscopic ultrasonography (EUS) fine-needle aspiration (FNA). Methods: We collected a minimum of 6 FNA samples from each of 250 patients during EUS. CC or DIA and FISH analyses were performed on every other specimen (from every other FNA pass); patients were randomly assigned to the first test performed. CC slides were reviewed by gastrointestinal cytopathologists who were blinded to all data. Findings from cytohistologic analysis, after a minimum 24-month follow-up period, were used as the standard (n = 202; median age, 65 years). Results: Aspirates were collected from lymph nodes (n = 111), pancreas (n = 61), gastrointestinal lumen wall (n = 9), periluminal mass (n = 4), liver (n = 8), and miscellaneous sites (n = 9). Matched samples provided a mean of 3.2 passes for CC and 1.6 passes for DIA and FISH. The data indicate a potential lack of utility for DIA. The combination of CC and FISH detected malignancy with 11% greater sensitivity than CC alone (P =.0002), but specificity was reduced from 100% to 96%. Conclusions: FISH analysis identifies neoplastic lesions with significantly greater sensitivity than CC in patients with diverse pathologies who underwent EUS with FNA, despite limited tissue sampling for FISH analysis.

Original languageEnglish (US)
JournalGastroenterology
Volume142
Issue number5
DOIs
StatePublished - May 2012

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Endoscopic Ultrasound-Guided Fine Needle Aspiration
Cell Biology
Fluorescence In Situ Hybridization
Fine Needle Biopsy
Endosonography
Neoplasms
Pancreas
Pathologic Constriction
Lymph Nodes
Pathology

Keywords

  • Cancer Detection
  • Diagnostic
  • Molecular Cytogenetic Marker
  • Pathology

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Comparison of methods to detect neoplasia in patients undergoing endoscopic ultrasound-guided fine-needle aspiration. / Levy, Michael J.; Oberg, Trynda N.; Campion, Michael B.; Clayton, Amy C.; Halling, Kevin C.; Henry, Michael R.; Kipp, Benjamin R.; Sebo, Thomas J.; Zhang, Jun; Enders, Felicity T; Clain, Jonathan E.; Gleeson, Ferga C.; Rajan, Elizabeth; Roberts, Lewis Rowland; Topazian, Mark; Wang, Kenneth Ke Ning; Gores, Gregory James.

In: Gastroenterology, Vol. 142, No. 5, 05.2012.

Research output: Contribution to journalArticle

Levy, MJ, Oberg, TN, Campion, MB, Clayton, AC, Halling, KC, Henry, MR, Kipp, BR, Sebo, TJ, Zhang, J, Enders, FT, Clain, JE, Gleeson, FC, Rajan, E, Roberts, LR, Topazian, M, Wang, KKN & Gores, GJ 2012, 'Comparison of methods to detect neoplasia in patients undergoing endoscopic ultrasound-guided fine-needle aspiration', Gastroenterology, vol. 142, no. 5. https://doi.org/10.1053/j.gastro.2012.02.002
Levy, Michael J. ; Oberg, Trynda N. ; Campion, Michael B. ; Clayton, Amy C. ; Halling, Kevin C. ; Henry, Michael R. ; Kipp, Benjamin R. ; Sebo, Thomas J. ; Zhang, Jun ; Enders, Felicity T ; Clain, Jonathan E. ; Gleeson, Ferga C. ; Rajan, Elizabeth ; Roberts, Lewis Rowland ; Topazian, Mark ; Wang, Kenneth Ke Ning ; Gores, Gregory James. / Comparison of methods to detect neoplasia in patients undergoing endoscopic ultrasound-guided fine-needle aspiration. In: Gastroenterology. 2012 ; Vol. 142, No. 5.
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AU - Levy, Michael J.

AU - Oberg, Trynda N.

AU - Campion, Michael B.

AU - Clayton, Amy C.

AU - Halling, Kevin C.

AU - Henry, Michael R.

AU - Kipp, Benjamin R.

AU - Sebo, Thomas J.

AU - Zhang, Jun

AU - Enders, Felicity T

AU - Clain, Jonathan E.

AU - Gleeson, Ferga C.

AU - Rajan, Elizabeth

AU - Roberts, Lewis Rowland

AU - Topazian, Mark

AU - Wang, Kenneth Ke Ning

AU - Gores, Gregory James

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N2 - Background & Aims: Digital image analysis (DIA) and fluorescence in situ hybridization (FISH) can be used to evaluate biliary strictures with greater accuracy than conventional cytology (CC). We performed a prospective evaluation of the accuracy of CC, compared with that of DIA and FISH, in detection of malignancy in patients undergoing endoscopic ultrasonography (EUS) fine-needle aspiration (FNA). Methods: We collected a minimum of 6 FNA samples from each of 250 patients during EUS. CC or DIA and FISH analyses were performed on every other specimen (from every other FNA pass); patients were randomly assigned to the first test performed. CC slides were reviewed by gastrointestinal cytopathologists who were blinded to all data. Findings from cytohistologic analysis, after a minimum 24-month follow-up period, were used as the standard (n = 202; median age, 65 years). Results: Aspirates were collected from lymph nodes (n = 111), pancreas (n = 61), gastrointestinal lumen wall (n = 9), periluminal mass (n = 4), liver (n = 8), and miscellaneous sites (n = 9). Matched samples provided a mean of 3.2 passes for CC and 1.6 passes for DIA and FISH. The data indicate a potential lack of utility for DIA. The combination of CC and FISH detected malignancy with 11% greater sensitivity than CC alone (P =.0002), but specificity was reduced from 100% to 96%. Conclusions: FISH analysis identifies neoplastic lesions with significantly greater sensitivity than CC in patients with diverse pathologies who underwent EUS with FNA, despite limited tissue sampling for FISH analysis.

AB - Background & Aims: Digital image analysis (DIA) and fluorescence in situ hybridization (FISH) can be used to evaluate biliary strictures with greater accuracy than conventional cytology (CC). We performed a prospective evaluation of the accuracy of CC, compared with that of DIA and FISH, in detection of malignancy in patients undergoing endoscopic ultrasonography (EUS) fine-needle aspiration (FNA). Methods: We collected a minimum of 6 FNA samples from each of 250 patients during EUS. CC or DIA and FISH analyses were performed on every other specimen (from every other FNA pass); patients were randomly assigned to the first test performed. CC slides were reviewed by gastrointestinal cytopathologists who were blinded to all data. Findings from cytohistologic analysis, after a minimum 24-month follow-up period, were used as the standard (n = 202; median age, 65 years). Results: Aspirates were collected from lymph nodes (n = 111), pancreas (n = 61), gastrointestinal lumen wall (n = 9), periluminal mass (n = 4), liver (n = 8), and miscellaneous sites (n = 9). Matched samples provided a mean of 3.2 passes for CC and 1.6 passes for DIA and FISH. The data indicate a potential lack of utility for DIA. The combination of CC and FISH detected malignancy with 11% greater sensitivity than CC alone (P =.0002), but specificity was reduced from 100% to 96%. Conclusions: FISH analysis identifies neoplastic lesions with significantly greater sensitivity than CC in patients with diverse pathologies who underwent EUS with FNA, despite limited tissue sampling for FISH analysis.

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