Improved diagnostic yield of endoscopic biliary brush cytology by digital image analysis

Objective: To evaluate the accuracy of digital image analysis (DIA) for dis tinguishing between benign and malignant strictures of the biliary tract. Patients and Methods: Our pathology databank was used to identify all bilia ry brush cytology specimens obtained during endoscopic retrograde cholangio pancreatography between June 1997 and June 1999, Corresponding medical reco rds were reviewed to determine whether patients had benign or malignant str ictures, Strictures were further classified into benign strictures with neg ative routine cytology, malignant strictures with negative routine cytology , and malignant strictures with positive routine cytology, Papanicolaou-sta ined smears of available brush cytology specimens were destained and then r estained with Feulgen dye. Nuclear images were quantified for DNA content w ithout knowledge of stricture type, DNA histograms were generated and ploid y results compared with the class of stricture, Results: We analyzed 27 specimens from 69 confirmed benign or malignant str ictures. Assuming that the presence of any aneuploid cells indicated malign ancy, the sensitivity of DIA was 85%. Furthermore, aneuploid cells were det ected by DIA in 13 of 16 specimens in which routine cytology was unrevealin g, Conclusion: Ploidy assessment by DIA has potential to enhance the sensitivi ty of diagnosing malignant strictures compared with routine cytology alone.