University of Miami, Miami, Florida 33136, USA.
Gastrointest Endosc. 2011 Sep;74(3):541-7. doi: 10.1016/j.gie.2011.04.043. Epub 2011 Jul 12.
Detection of chromosomal abnormalities by fluorescence in situ hybridization (FISH) analysis has not been well-studied in FNA samples of pancreatic masses. Selective use of FISH in patients with inconclusive on-site cytopathology results may improve the sensitivity of EUS for malignancy.
To determine the sensitivity and specificity of FISH analysis in patients with inconclusive on-site cytopathology results.
Consecutive patients with suspected pancreatic malignancy, nonrandomized cohort study. Final diagnosis was based on either surgical biopsy or disease progression on extended follow-up or death.
Academic center, tertiary-care referral cancer center.
A total of 212 EUS examinations were performed in 206 patients for solid pancreatic lesions over a 24-month period (January 2009-December 2010). FISH analysis was done for 69 patients with inconclusive or nonavailable on-site cytology results.
EUS-guided FNA (EUS-FNA) of solid pancreatic masses with cytology and FISH analysis for polysomy of chromosomes 3, 7, and 17 and deletion of 9p21.
Sensitivity/specificity of cytology, FISH, and a composite of cytology and FISH.
Patients with positive on-site cytology (110), neuroendocrine tumors (22), insufficient follow-up (1), FISH not obtained (3), and renal cancer with pancreatic metastasis (1) were excluded. Sixty-nine patients comprised the study cohort, 54 with malignancy and 15 with benign disease. Sensitivity for malignancy of cytology, FISH analysis, and the combination were 61%, 74%, and 85%, respectively (P = .009). FISH detected an additional 13 cases of pancreatic adenocarcinoma missed by cytology. There was no false-positive FISH analysis in 15 patients with benign disease. No major complications occurred from EUS-FNA.
Single center, selected patients underwent FISH analysis, limited number of patients with benign disease.
In patients with suspected pancreatic cancer, FISH analysis can detect additional cases missed by cytology without compromising specificity. FISH analysis to detect polysomy of chromosomes 3, 7, and 17 and deletion of 9p21 should be considered when cytology is negative for malignancy in patients with a known pancreatic mass.
荧光原位杂交（FISH）分析检测染色体异常在胰腺肿块的细针抽吸活检（FNA）样本中研究甚少。在现场细胞学检查结果不确定的患者中选择性使用 FISH 可能会提高 EUS 对恶性肿瘤的敏感性。
确定现场细胞学检查结果不确定的患者中 FISH 分析的敏感性和特异性。
连续入选疑似胰腺恶性肿瘤的患者，非随机队列研究。最终诊断基于手术活检或延长随访期间的疾病进展或死亡。
学术中心，三级癌症转诊中心。
在 24 个月的时间里（2009 年 1 月至 2010 年 12 月），共有 206 名患者因胰腺实性病变接受了 212 次 EUS 检查。对 69 名现场细胞学检查结果不确定或无法获得的患者进行了 FISH 分析。
EUS 引导下 FNA（EUS-FNA）对胰腺实性肿块进行细胞学检查和 FISH 分析，检测染色体 3、7 和 17 的三倍体和 9p21 缺失。
细胞学、FISH 以及细胞学和 FISH 联合检测的敏感性/特异性。
排除了现场细胞学检查阳性（110 例）、神经内分泌肿瘤（22 例）、随访不足（1 例）、未进行 FISH 检测（3 例）和伴有胰腺转移的肾癌（1 例）患者。69 例患者为研究队列，54 例为恶性肿瘤，15 例为良性疾病。细胞学、FISH 分析和联合检测的恶性肿瘤敏感性分别为 61%、74%和 85%（P =.009）。FISH 检测到 13 例细胞学检查遗漏的胰腺腺癌。在 15 例良性疾病患者中，FISH 检测没有假阳性。EUS-FNA 未发生严重并发症。
单中心，选择的患者进行了 FISH 分析，良性疾病患者数量有限。
在疑似胰腺癌患者中，FISH 分析可以在细胞学检查为恶性肿瘤阴性时检测到被遗漏的额外病例，而不会影响特异性。当已知胰腺肿块患者的细胞学检查结果为恶性肿瘤阴性时，应考虑 FISH 分析以检测染色体 3、7 和 17 的三倍体和 9p21 缺失。
