Biliary Tract Malignancy

Bile Duct Calculator

September 2011

This slide shows that we will interpret any case in which the likelihood of malignancy is predicted to be >98% as consistent with malignancy but that if the prediction of malignancy is between 85 and 98% we will call it suspicious for malignancy. If there are 1 or more abnormal test results (for example an atypical cytology result but a negative FISH result) and the calculator predicts a risk of <85% then we will interpret the case as equivocal for the presence of tumor. At this time I am going to hand things back to Dr. Gores who will describe several typical cases in which the combination of conventional cytology and FISH were used to help to determine if a patient had a pancreatobiliary tumor. Thank you.

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• 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
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• Questions?