Περίληψη:
BACKGROUND: Cholangiocarcinoma is a very aggressive tumor with poor
survival. Therefore, early diagnosis and surgical resection are of
paramount importance. Its diagnosis is difficult because access to the
tumor is not easy. Biopsy is possible only for intrahepatic
cholangiocarcinoma, which accounts for 10% of cases. Routine brush
cytology from endoscopic retrograde cholangiopancreatography (ERCP) has
a high specificity of 100% but unfortunately a low sensitivity of 30%.
In this review we briefly describe new diagnostic techniques applicable
to ERCP brush cytology specimens and targeting the genetic background of
the disease, in particular fluorescence in situ hybridization (FISH) and
digital image analysis (DIA).
DATE SOURCES: The PubMed database up to 2011 was used for the retrieval
of relevant articles. The search terms FISH, fluorescence in situ
hybridization, DIA, digital image analysis and cholangiocarcinoma were
used. Both original and review articles were used.
RESULTS: FISH identifies cells with chromosomal abnormalities, mainly
numerical aberrations, using a mixture of fluorescence-labeled probes.
FISH offers a higher sensitivity than routine cytology, retaining a high
level of specificity The DIA criterion for malignancy is demonstration
of aneuploidy. This technique increases the sensitivity to 40%, but the
specificity remains low. Preliminary data from application to other
tumors suggest that combination of FISH and DIA may be of further
benefit.
CONCLUSIONS: The new techniques offer a significantly enhanced
diagnostic efficacy in the evaluation of ERCP brush specimens. Apart
from contributing to a more timely diagnosis, their wider application to
cholangiocarcinoma may also facilitate the genetic study of the disease
and add to our understanding of oncogenesis at the molecular level, with
the prospect of identifying targets for novel therapeutic interventions.
(Hepatobiliary Pancreat Dis Int 2012;11:349-359)
Συγγραφείς:
Vasilieva, Larisa E.
Papadhimitriou, Stefanos I.
Dourakis,
Spyros P.
