Fluorescence in situ hybridization for diagnosis of cholangiocarcinoma in primary sclerosing cholangitis: a systematic review and meta-analysis.

BACKGROUND

Patients with primary sclerosing cholangitis (PSC) are at risk of developing cholangiocarcinoma (CCA). Fluorescence in situ hybridization (FISH) may aid diagnosis of CCA.

OBJECTIVE

To determine the diagnostic utility of FISH for CCA detection in patients with PSC.

DESIGN

Meta-analysis.

SETTING

Tertiary-care medical center.

PATIENTS

Patients in studies where histopathologic correlation of CCA was available; 2 × 2 contingency data were constructed.

INTERVENTION

Database search and review of study findings.

MAIN OUTCOME MEASUREMENTS

Sensitivity, specificity, likelihood ratio, and pooled diagnostic odds ratio.

RESULTS

The search yielded 8 studies, involving 828 patients who could be included in our meta-analysis. The pooled sensitivity and specificity of FISH for diagnosis of CCA in patients with PSC were 68% (95% confidence interval [CI], 61%-74%) and 70% (95% CI, 66%-73%), respectively. The pooled positive likelihood ratio was 2.69 (95% CI, 1.84-3.97), and the negative likelihood ratio was 0.47 (95% CI, 0.39-0.58). The pooled diagnostic odds ratio was 7.24 (95% CI, 3.93-13.36). For FISH polysomy (6 studies, n = 690), the pooled sensitivity and specificity of FISH were 51% (95% CI, 43%-59%) and 93% (95% CI, 91%-95%), respectively. The heterogeneity indices of I(2) measure of inconsistency was 45.9%. Visual inspection of the funnel plot showed low potential for publication bias.

LIMITATIONS

Inclusion of low-quality studies.

CONCLUSION

Our study suggests that FISH polysomy is highly specific; however, limited sensitivity of FISH highlights that better markers are required for early detection of CCA in PSC.