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Endoscopic retrograde cholangiopancreatography (ERCP) is used to examine patients with biliary tract obstruction or stricture for possible malignancy. Biopsies and cytologic specimens are obtained at the time of ERCP. Cytologic analysis complements biopsy by sometimes detecting malignancy in patients with a negative biopsy. Nonetheless, a number of studies suggest that the overall sensitivity of bile duct brushing and bile aspirate cytology is quite low.
Fluorescence in situ hybridization (FISH) is a technique that utilizes fluorescently labeled DNA probes to examine cells for chromosomal alterations. FISH can be used to detect cells with chromosomal changes (eg, aneuploidy) that are indicative of malignancy. Studies in our laboratory indicate that the sensitivity of FISH to detect malignant cells in biliary brush specimens is superior to that of conventional cytology.
Assessing bile duct brushing or hepatobiliary brushing specimens for malignancy
A positive FISH result does not identify location or type of malignancy. FISH abnormalities may be associated with high-grade dysplasia or carcinoma in situ. Cytology and biopsy may help clarify such situations.
An interpretive report will be provided.
1. Barr Fritcher EG, Kipp BR, Voss JS, et al: The Development of a Tailored Pancreatobiliary Fluorescence in situ Hybridization (FISH) Assay to Improve Detection of Malignancy in Pancreatobiliary Brushings. J Mol Diagn 2013;15(6):909
2. 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;136(7):2180-2186