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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Gastroenterology 1/2014

The added value of using mutational profiling in addition to cytology in diagnosing aggressive pancreaticobiliary disease: review of clinical cases at a single center

Zeitschrift:
BMC Gastroenterology > Ausgabe 1/2014
Autoren:
Nidhi Malhotra, Sara A Jackson, Lindsay L Freed, Mindi A Styn, Mary K Sidawy, Nadim G Haddad, Sydney D Finkelstein
Wichtige Hinweise

Competing interests

RedPath Integrated Pathology (RedPath) sponsored this study. Nidhi Malhotra, M.D., Mary Sidawy, M.D., and Nadim Haddad, M.D. received no financial support from RedPath. Sydney Finkelstein, M.D., is a founder of RedPath Integrated Pathology (RedPath). He is the current Chief Scientific Officer and is a shareholder at RedPath. Sara Jackson, Ph.D., Lindsay Freed, B.S., and Mindi Styn, Ph.D., are employees of RedPath. Nidhi Malhotra, M.D., Mary Sidawy, M.D., and Nadim Haddad, M.D. have no competing interests.

Authors’ contributions

NM, SJ, LF, MAS, and SF participated in the conception/design of study, analysis/interpretation of data, study supervision, drafting of manuscript, and critical revision of manuscript. NH participated in the conception/design of study, analysis/interpretation of data, study supervision, and critical revision of manuscript. MKS participated in the conception/design of study and critical revision of manuscript. NM, SJ, LF, MAS, MKS, NH, and SF read and approved the final manuscript.

Abstract

Background

This study aimed to better understand the supporting role that mutational profiling (MP) of DNA from microdissected cytology slides and supernatant specimens may play in the diagnosis of malignancy in fine-needle aspirates (FNA) and biliary brushing specimens from patients with pancreaticobiliary masses.

Methods

Cytology results were examined in a total of 30 patients with associated surgical (10) or clinical (20) outcomes. MP of DNA from microdissected cytology slides and from discarded supernatant fluid was analyzed in 26 patients with atypical, negative or indeterminate cytology.

Results

Cytology correctly diagnosed aggressive disease in 4 patients. Cytological diagnoses for the remaining 26 were as follows: 16 negative (9 false negative), 9 atypical, 1 indeterminate. MP correctly determined aggressive disease in 1 false negative cytology case and confirmed a negative cytology diagnosis in 7 of 7 cases of non-aggressive disease. Of the 9 atypical cytology cases, MP correctly diagnosed 7 as positive and 1 as negative for aggressive disease. One specimen that was indeterminate by cytology was correctly diagnosed as non-aggressive by MP. When first line malignant (positive) cytology results were combined with positive second line MP results, 12/21 cases of aggressive disease were identified, compared to 4/21 cases identified by positive cytology alone.

Conclusions

When first line cytology results were uncertain (atypical), questionable (negative), or not possible (non-diagnostic/indeterminate), MP provided additional information regarding the presence of aggressive disease. When used in conjunction with first line cytology, MP increased detection of aggressive disease without compromising specificity in patients that were difficult to diagnose by cytology alone.
Literatur
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