Biliary Tract Malignancy

Sensitivity and Specificity of Various Tests for Detection of Pancreatobiliary Strictures Malignancy

September 2011

As I mentioned in the previous slide, our lab has clinically validated the FISH probe set that we use for detecting pancreatobiliary malignancy. We did this by determining the clinical sensitivity and specificity of the assay in a large cohort of patients that were being evaluated for pancreatobiliary malignancy. We also simultaneously determined the clinical performance characteristics of conventional cytology and DIA for the detection of pancreatobiliary malignancy. On the left, this figure shows that if only positive cytology diagnoses were considered consistent with malignancy that cytology had a sensitivity of about 20% and a specificity of 100%. If both positive and suspicious cytology interpretations were considered consistent with malignancy then the sensitivity of cytology was about 38% and its specificity was about 97%. If positive, suspicious and atypical cytology interpretations were all considered consistent with malignancy then the sensitivity of cytology increased to about 50% but the specificity dropped to about 85%. We no longer use DIA so I will not talk about that. But this slide also shows that if only polysomic FISH diagnoses were considered consistent with malignancy that the sensitivity of FISH was about 42% with a specificity close to 100%. If both polysomic and trisomic FISH findings were considered consistent with malignancy the sensitivity jumped to 62% but the specificity dropped to about 79%. This further demonstrates the lack of specificity that trisomy has for the presence of malignancy.

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Jump to section:

• Introduction
• Disclosures
• Pancreatobiliary Strictures (PBS)
• Primary Sclerosing Cholangitis (PSC)
• Pancreatobiliary Strictures (PBS)
• Bile Duct Brushings
• Current Clinical Practice
• Factors That Influence Sensitivity Of Cytology Specimens
• Routine Cytology
• Cancer Is A Genetic Disorder That Results From Mutations
• Detecting Tumor Cells in Cytology Specimens Using FISH
• Types of FISH Probes
• FISH
• Sensitivity and Specificity of Various Tests for Detection of Pancreatobiliary Strictures Malignancy
• What Do We Do With These Data?
• Bile Duct Pathology Calculator
• Representative Test Report Using Bile Duct Calculator
• Bile Duct Calculator
• Impact of Disease Prevalence on Positive Predictive Value (PPV)
• Case 1
• Case 1 Cytologic Findings
• Case 1
• Case 1 Test Report Using Bile Duct Calculator
• Case 1
• Case 1
• Case 2
• Case 2 Cytologic Findings
• Case 2
• Case 2: Test Report Using Bile Duct Calculator
• Case 2
• Case 2
• Case 3
• Case 3 Cytologic Findings
• Case 3
• Case 3
• Case 3: Test Report Using Bile Duct Calculator
• Case 3
• Case 3
• Summary
• Summary
• Results
• Questions?