Biliary Tract Malignancy:
Improved Detection with Cytology and FISH Test
Updated: June 2013
Published: July 2011
Cancers involving the bile ducts (biliary tract malignancy) are frequently difficult to diagnose. The tumors that most frequently involve the biliary tract are pancreatic cancer and cholangiocarcinoma, a tumor that arises from the epithelial lining of the bile duct. Mayo Clinic offers a test to assess for biliary tract malignancy through the combination of cytology and molecular testing by fluorescence in situ hybridization (FISH). This test is particularly useful when evaluating patients with primary sclerosing cholangitis (PSC) who are at high risk for developing cholangiocarcinoma.
The FISH test was developed within the Mayo Clinic Department of Laboratory Medicine and Pathology and is widely used by physicians in our Hepatology Clinic, Pancreas Clinic, Transplant Service, and by our Advanced Therapeutic Endoscopists as a routine part of patient care. The test has significantly greater sensitivity for detecting biliary tract tumors than cytology alone. The pairing of molecular testing with cytology often enables tumor detection and delivery of care at an earlier disease stage, thereby offering the potential to reduce patient mortality and reduce overall health care costs.
Based on clinical correlations from the Mayo Clinic patient population, Mayo Medical Laboratories has developed a prediction model that utilizes the patient’s age, cytology result, FISH result, and PSC status to determine the likelihood that a patient has a malignancy involving the biliary tract and this information is provided in the interpretation of the patient’s report.(1)
The test does not require a surgical pathology consult. Clients may send samples to Mayo Medical Laboratories for both cytology and FISH testing or FISH testing alone.
- Biliary Tract Malignancy, Cytology & FISH
- Biliary Tract Malignancy, FISH Only
- Both tests useful for assessing bile duct brushing or hepatobiliary brushing specimens for malignancy
- Disease states: bile duct cancer (cholangiocarcinoma), pancreatic cancer, primary sclerosing cholangitis (PSC)
Mayo Clinic Video
- Using Cytology and FISH Test to Detect Biliary Tract Malignancies, Mayo Clinic video by Michael J. Levy, MD, Division of Gastroenterology and Hepatology at Mayo Clinic and Renee Root CT (ASCP), Division of Molecular Anatomic Pathology at Mayo Clinic
- Barr Fritcher EG, Kipp BR, Halling KC, et al: A Multivariable Model Using Advanced Cytologic Methods for the Evaluation of Indeterminate Pancreatobiliary Strictures. Gastroenterology 2009 June;136:2180-2186
- Kipp BR, Stadheim LM, Halling SA, et al: A comparison of routine cytology and fluorescence in situ hybridization for the detection of malignant bile duct strictures. Am J Gastroenterol 2004 September;99(9):1675-1681
- Moreno Luna LE, Kipp BR, Halling KC, et al: Advanced cytologic techniques for the detection of malignant pancreatobiliary strictures. Gastroenterology 2006 October;131(4):1064-1072
- Barr Fritcher EG, Kipp BR, Slezak JM, et al: Correlating routine cytology, quantitative nuclear morphometry by digital image analysis, and genetic alterations by fluorescence in situ hybridization to assess the sensitivity of cytology for detecting pancreatobiliary tract malignancy. Am J Clin Pathol 2007 August;128(2):272-279