IMAGE CYTOMETRY AS A DISCRIMINATORY TOOL FOR CYTOLOGIC SPECIMENS OBTAINED BY ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

BACKGROUND. Routine brush cytology is relatively insensitive for the d iagnosis of biliary and pancreatic malignancy. Sensitivity can be impr oved by measuring DNA and proliferation. The goal of this study was to assess the discriminatory capacity of image cytometry using pancreati cobiliary brush cytology specimens obtained during endoscopic retrogra de cholangiopancreatography (ERCP). Analysis included morphometry, DNA quantification, and characterization of nuclear chromatin distributio n and condensation. METHODS. Brush cytology specimens were obtained du ring ERCP from 22 chronic pancreatitis specimens, 11 pancreatic adenoc arcinoma specimens, 13 primary sclerosing cholangitis specimens, and 1 1 cholangiocarcinoma specimens and contrasted with 25 normal epithelia specimens. A SAMBA 2005 image processor was used to analyze Feulgen s tained chromatin density and distribution. Discriminant analysis of 37 morphonuclear variables was performed to characterize differences bet ween: 1) chronic pancreatitis and pancreatic adenocarcinoma, and 2) pr imary sclerosing cholangitis and cholangiocarcinoma. RESULTS. Chronic pancreatitis was distinguished from pancreatic adenocarcinoma (P less than or equal to 0.001); sensitivity and specificity were both estimat ed to be 82%. Primary sclerosing cholangitis was distinguished from ch olangiocarcinoma (P less than or equal to 0.01); sen sitivity and spec ificity were estimated to be 82% and 85%, respectively. CONCLUSIONS. M ultiparameter image cytometry has potential as an adjuvant diagnostic technique in patients with pancreaticobiliary malignancy. (C) 1998 Ame rican Cancer Society.