Equivocal cytology in XXXX diagnosis: improvement of diagnostic accuracy using adjuvant multicolor FISH, DNA-image cytometry, and quantitative promoter hypermethylation analysis.

@entity1 @entity986 @entity5 @entity2 @entity9736 @entity15893
BACKGROUND: Sometimes, cytological @entity2 diagnosis is challenging because equivocal diagnoses are common. To enhance diagnostic accuracy, fluorescent in situ hybridization (FISH), DNA-image cytometry, and quantitative promoter hypermethylation analysis have been proposed as adjuncts. METHODS: Bronchial washings and/or brushings or transbronchial fine-needle aspiration biopsies were prospectively collected from @entity1 who were clinically suspected of having @entity2 . After routine cytological diagnosis, 70 consecutive specimens, each cytologically diagnosed as negative, equivocal, or positive for @entity5 cells, were investigated with adjuvant methods. Suspicious areas on the smears were restained with the LAVysion multicolor FISH probe set (Abbott Molecular, Des Plaines, Illinois) or according to the Feulgen Staining Method for DNA-image cytometry analysis. DNA was extracted from residual liquid material, and frequencies of aberrant methylation of APC, @entity986 ( @entity986 ) , and @entity15893 gene promoters were determined with quantitative methylation-specific polymerase chain reaction (QMSP) after @entity9736 conversion. Clinical and histological follow-up according to a reference standard, defined in advance, were available for 198 of 210 @entity1 . RESULTS: In the whole cohort, cytology, FISH, DNA-image cytometry, and QMSP achieved sensitivities of 83.7%, 78%, 79%, and 49.6%, respectively (specificities of 69.8%, 98.2%, 98.2%, and 98.4%, respectively). Subsequent to cytologically equivocal diagnoses, FISH, DNA-image cytometry, and QMSP definitely identified @entity5 in 79%, 83%, and 49%, respectively. With QMSP, 4 of 22 @entity5 @entity1 with cytologically negative diagnoses were correctly identified. CONCLUSIONS: Thus, adjuvant FISH or DNA-image cytometry in cytologically equivocal diagnoses improves diagnostic accuracy at comparable rates. Adjuvant QMSP in cytologically negative cases with persistent suspicion of @entity2 would enhance sensitivity.
