Biliary Tract Malignancy

Summary

September 2011

Addition of ancillary tests such as FISH for polysomy cell detection has improved sensitivity to identify malignancy in brush cytology from pancreatobiliary specimens. This test aides and helps modulate equivocal cytologic results providing 1 more piece of information that helps the clinician make a treatment and follow-up decision. They can also be reassuring if the cytology results run counter from the clinical impression. The enhanced sensitivity allows for an earlier diagnosis of potential cancer and therefore, cure. This approach also allows for an individualized medical approach with a statistical calculation of risk. Experience also helps to better understand limitations of test modalities over time.

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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
• Results
• Questions?