Thesis Project PPT

7/30/2019 Thesis Project PPT

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Thesis presentation

A study of DNA ploidy by image analysis versusroutine cytology in the detection of malignantbiliary stricturesDr Rajwant Kaur


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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.


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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.


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Contd

DNA image analysis

1. Smears stained using Feulgen method.

2. Photomicrographs of areas of interest.

3. At least 100 cells studied in each case.

4. The desirable nuclei were traced manually and integrated optical density

(IOD) of selected nuclei measured.

5. Data collected was transferred to Microsoft excel sheet.

6. DNA histograms were generated for ploidy analysis by plotting individual

DNA nuclear content (X-axis) against number of nuclei (Y-axis).


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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 aspirationClinical follow-up of at least 6 months


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Results

Clinical data

1. Mean age of patients was 54.60 11 years.

2. Female preponderance with M:F of 1:1.8.

3. However no gender predilection was seen among benign and malignantgroup.

4. Chief presenting complaint in patients was jaundice and pain abdomen.

5. Mean values of liver function tests did not vary significantly in benign and

malignant categories.


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Results

Cytologic analysis


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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.


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Results

Modality

used

Sensitivity

(%)

Specificity

(%)

Negative

predictive

value (%)

Positive

predictive

value (%)

Diagnostic

accuracy

(%)

Cytology 66.67 100 60.71 100 66

DNA image

analysis

69.4 100 56 100 72


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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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