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

Michael J. Levy, Jonathan E. Clain, Amy Clayton, Kevin C. Halling, Benjamin R. Kipp, Elizabeth Rajan, Lewis Rowland Roberts, Renee M. Root, Thomas J. Sebo, Mark Topazian, Kenneth Ke Ning Wang, Maurits J. Wiersema, Gregory James Gores

Research output: Contribution to journalArticle

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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. Design: Patients enrolled with known or suspected malignancy. The final diagnosis was based on strict cytopathologic and imaging criteria and 12-month follow-up. Settings: Tertiary referral center. Patients: 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). Interventions: EUS-guided FNA with RC, DIA, and FISH. Main Outcome Measurement: 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. Limitations: 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.

Original languageEnglish (US)
Pages (from-to)483-490
Number of pages8
JournalGastrointestinal Endoscopy
Volume66
Issue number3
DOIs
StatePublished - Sep 2007

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Endoscopic Ultrasound-Guided Fine Needle Aspiration
Fluorescence In Situ Hybridization
Cell Biology
Neoplasms
Adenocarcinoma
Tumor Biomarkers
Thyroid Neoplasms
Small Cell Sarcoma
Stomach
Mucinous Adenocarcinoma
Routine Diagnostic Tests
Forearm
Tertiary Care Centers
Non-Small Cell Lung Carcinoma
Melanoma
Lymphoma
Thyroid Gland
Pathologic Constriction
Sensitivity and Specificity

ASJC Scopus subject areas

  • Gastroenterology

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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. / Levy, Michael J.; Clain, Jonathan E.; Clayton, Amy; Halling, Kevin C.; Kipp, Benjamin R.; Rajan, Elizabeth; Roberts, Lewis Rowland; Root, Renee M.; Sebo, Thomas J.; Topazian, Mark; Wang, Kenneth Ke Ning; Wiersema, Maurits J.; Gores, Gregory James.

In: Gastrointestinal Endoscopy, Vol. 66, No. 3, 09.2007, p. 483-490.

Research output: Contribution to journalArticle

Levy, Michael J. ; Clain, Jonathan E. ; Clayton, Amy ; Halling, Kevin C. ; Kipp, Benjamin R. ; Rajan, Elizabeth ; Roberts, Lewis Rowland ; Root, Renee M. ; Sebo, Thomas J. ; Topazian, Mark ; Wang, Kenneth Ke Ning ; Wiersema, Maurits J. ; Gores, Gregory James. / 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. In: Gastrointestinal Endoscopy. 2007 ; Vol. 66, No. 3. pp. 483-490.
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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. Design: Patients enrolled with known or suspected malignancy. The final diagnosis was based on strict cytopathologic and imaging criteria and 12-month follow-up. Settings: Tertiary referral center. Patients: 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). Interventions: EUS-guided FNA with RC, DIA, and FISH. Main Outcome Measurement: 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. Limitations: 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.",
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T1 - 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

AU - Levy, Michael J.

AU - Clain, Jonathan E.

AU - Clayton, Amy

AU - Halling, Kevin C.

AU - Kipp, Benjamin R.

AU - Rajan, Elizabeth

AU - Roberts, Lewis Rowland

AU - Root, Renee M.

AU - Sebo, Thomas J.

AU - Topazian, Mark

AU - Wang, Kenneth Ke Ning

AU - Wiersema, Maurits J.

AU - Gores, Gregory James

PY - 2007/9

Y1 - 2007/9

N2 - 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. Design: Patients enrolled with known or suspected malignancy. The final diagnosis was based on strict cytopathologic and imaging criteria and 12-month follow-up. Settings: Tertiary referral center. Patients: 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). Interventions: EUS-guided FNA with RC, DIA, and FISH. Main Outcome Measurement: 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. Limitations: 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.

AB - 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. Design: Patients enrolled with known or suspected malignancy. The final diagnosis was based on strict cytopathologic and imaging criteria and 12-month follow-up. Settings: Tertiary referral center. Patients: 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). Interventions: EUS-guided FNA with RC, DIA, and FISH. Main Outcome Measurement: 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. Limitations: 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.

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