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Thesis Project

The document summarizes a study that evaluated the efficacy of cytomorphology (routine cytology) versus DNA image analysis (DIA) in detecting malignant cells in bile duct brushing specimens. 50 bile duct brushing specimens were analyzed using cytology and DIA. Cytology detected malignant cells with 66.67% sensitivity and 100% specificity, while DIA detected malignant cells with 69.4% sensitivity and 100% specificity, only a marginal improvement over cytology alone. The study concludes that cytology remains the diagnostic modality of choice for biliary strictures, and combining it with DIA only results in a small increase in sensitivity.

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Sonu Dhangar
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92 views10 pages

Thesis Project

The document summarizes a study that evaluated the efficacy of cytomorphology (routine cytology) versus DNA image analysis (DIA) in detecting malignant cells in bile duct brushing specimens. 50 bile duct brushing specimens were analyzed using cytology and DIA. Cytology detected malignant cells with 66.67% sensitivity and 100% specificity, while DIA detected malignant cells with 69.4% sensitivity and 100% specificity, only a marginal improvement over cytology alone. The study concludes that cytology remains the diagnostic modality of choice for biliary strictures, and combining it with DIA only results in a small increase in sensitivity.

Uploaded by

Sonu Dhangar
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Thesis presentation

A study of DNA ploidy by image analysis versus routine cytology in the detection of malignant biliary strictures Dr Rajwant Kaur

Aims and Objectives


To evaluate efficacy of cytomorphology in detection of malignant cells in pancreaticobiliary brushing specimens. To assess whether DIA can be used as an ancillary technique to improve diagnostic yield of malignant cells in bile duct brushing specimens.

Materials and methods


The present study was conducted on 50 bile duct brushing specimens collected during ERCP. Patients having pancreaticobiliary strictures, irrespective of their age and sex were included in the study. Cytologic examination: May Grnwald Giemsa (MGG) on air dried smears Haematoxylin and eosin (H&E) on alcohol fixed smears On the basis of cytological examination, cases were classified as benign, atypical, suspicious for malignancy and malignant.

Contd
DNA image analysis 1. 2. 3. 4. 5. 6. Smears stained using Feulgen method. Photomicrographs of areas of interest. At least 100 cells studied in each case. The desirable nuclei were traced manually and integrated optical density (IOD) of selected nuclei measured. Data collected was transferred to Microsoft excel sheet. DNA histograms were generated for ploidy analysis by plotting individual DNA nuclear content (X-axis) against number of nuclei (Y-axis).

Contd
On DIA, the cases were classified depending upon measured IOD as Diploid - single peak and a DNA index of 0.9-1.1 Broad diploid - diploid peak with less than 10% of cells >5c Aneuploid - distinct aneuploid peak and a DNA index >1.1

Final diagnosis of benign or malignant stricture was made on Histopathologic confirmation Fine needle aspiration Clinical follow-up of at least 6 months

Results
Clinical data 1. 2. 3. 4. 5. Mean age of patients was 54.60 11 years. Female preponderance with M:F of 1:1.8. However no gender predilection was seen among benign and malignant group. Chief presenting complaint in patients was jaundice and pain abdomen. Mean values of liver function tests did not vary significantly in benign and malignant categories.

Results
Cytologic analysis

Results
DNA image analysis DIA detected aneuploid cells in 22 cases (56.4%), 3 cases (7.7%) were broad diploid and 14 (35.9%) were diploid out of 39 malignant cases.

No false positive case was seen on cytology or DIA.

Results
Modality used Sensitivity (%) Specificity (%) Negative predictive value (%)
60.71

Positive predictive value (%)


100

Diagnostic accuracy (%)


66

Cytology

66.67

100

DNA image analysis

69.4

100

56

100

72

Conclude
Present study emphasizes that for most strictures of biliary tract, cytology remains the diagnostic modality of choice. Combining cytomorphology with DNA image analysis resulted in only a marginal improvement in overall sensitivity in comparison to when cytology was used alone (69% versus 66%).

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