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Cellular Oncology
Volume 27, Issue 4, Pages 255-260

Digital Image DNA Cytometry: A Useful Tool for the Evaluation of Malignancy in Biliary Strictures

M. C. Osterheld,1 S. Andrejevic Blant,1 L. Caron,1 R. Braunschweig,1 G. Dorta,2 H. Bouzourene,1 and A. Mihaescu1

1Institut Universitaire de Pathologie, Bugnon 25, 1011 Lausanne, Switzerland
2Service de gastroenterologie, Centre Hospitalier Universitaire Vaudois, Bugnon 46, 1011 Lausanne, Switzerland

Copyright © 2005 Hindawi Publishing Corporation and the authors. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: Cytologic evaluation of the biliary tract strictures is nowadays widely used for distinguishing between benign and malignant lesions but remains a challenge for some problematic cases. Digital Image cytometry (DNA-cytometry) helps cytopathologists to resolve some unclear situations.

Methods: We have analysed 41 specimens of bile duct brushings obtained from patients during ERCP (11 benign cases, 7 suspicious for malignancy cases and 23 malignant cases) by DNA-cytometry and correlated them with the histological biopsy counterpart.

Results: All eleven cytological and histological benign cases were DNA-diploid and among 22 patients with malignant cytological and histological diagnosis 21 were DNA-aneuploid. One case considered malignant by the cytopathologist revealed DNA-aneuploid but malignancy could not be confirmed by histology. The analysis of the suspicious for malignancy cases revealed that all DNA-aneuploid cases were malignant and all DNA-diploid cases were benign referring to the follow-up of the patients.

The comparison between cytology alone and cytology combined with DNA-cytometry related to the histological diagnosis (gold standard) resulted in a sensitivity of 100% and a specificity of 79% for cytology alone; a specificity of 94% and a sensitivity 92% for DNA-cytometry and a specificity of 93% and a sensitivity of 100% with combined analyses. The positive predictive value was 90% for cytology, 96% for DNA-cytometry and for both analyses. The negative predictive value showed 100% for cytology, 89% for DNA-cytometry and 100% for combined studies.

Conclusions: Despite the limited number of patients involved in the study, the Results obtained indicate an increased of specificity and of positive predictive value using DNA-cytometry. These Results confirm the pertinence of these method for challenging cases, in conjunction with other available diagnostic tools.