Re: I need some interpretation

[Guest guest]

can someone interpret this for me:

The sensitivity of FISH for the bile aspirate specimens was 23%, and the

combined sensitivity of FISH for aspirate and brushing specimens was 35%. The

specificity of FISH and cytology brushings were 91% and 98% (p= 0.06),

respectively.

I went to Mayo again last week for another ERCP and got results today.

Apparently everything is good except the FISH test which shows abnormal

chromasomes. Now they want me back ASAP for an MRI. I asked the doctor about

cancer and she said it might not yet be cancer but clearly she thinks it is.

She said even if the tests are negative they will probalby want to transplant

me anyway. I pray to God this isnt cancer. Right now Im scared to death.

I watched my mom die of Pancreatic cancer just a few weeks ago and I really dont

want to die. As im sure i mentioned before i have a 3yr old little boy and a

1yr old little girl. All I care about is being around to watch them grow up.

Its just not a good time for this to happen. Any help on the stuff above would

be great.

Thanks to everyone.

Mark

[Guest guest]

Dear Mark;

The sentence you want interpreting is taken from the following

abstract:

Am J Gastroenterol. 2004 Sep;99(9):1675-81.

A comparison of routine cytology and fluorescence in situ

hybridization for the detection of malignant bile duct strictures.

Kipp BR, Stadheim LM, Halling SA, Pochron NL, Harmsen S, Nagorney

DM, Sebo TJ, Therneau TM, Gores GJ, de Groen PC, Baron TH, Levy MJ,

Halling KC, LR.

Department of Laboratory Medicine and Pathology, Mayo Clinic College

of Medicine, 200 First Street SW, Rochester, MN 55905, USA.

BACKGROUND AND AIM: The aim of this study was to assess the relative

sensitivities and specificities of fluorescence in situ

hybridization (FISH) and routine cytology for the detection of

malignancy in biliary tract strictures. METHODS: Bile duct brushing

and aspirate specimens were collected from 131 patients being

evaluated for possible malignant bile duct strictures. Both specimen

types were assessed by FISH but only brushing specimens were

assessed by cytology. The FISH assay used a mixture of fluorescently-

labeled probes to the centromeres of chromosomes 3, 7, and 17 and

chromosomal band 9p21 (Vysis UroVysion) to identify cells having

chromosomal abnormalities. A case was considered positive for

malignancy if five or more cells exhibited polysomy. RESULTS: Sixty-

six of the 131 patients had surgical pathologic and/or clinical

evidence of malignancy. Thirty-nine patients had cholangiocarcinoma,

19 had pancreatic carcinoma, and 8 had other types of malignancy.

The sensitivity of cytology and FISH for the detection of malignancy

in bile duct brushing specimens in these patients was 15% and 34% (p

< 0.01), respectively. The sensitivity of FISH for the bile aspirate

specimens was 23%, and the combined sensitivity of FISH for aspirate

and brushing specimens was 35%. The specificity of FISH and cytology

brushings were 91% and 98% (p= 0.06), respectively. CONCLUSIONS:

FISH is significantly more sensitive than and nearly as specific as

conventional cytology for the detection of malignant biliary

strictures in biliary brushing specimens. FISH may improve the

clinical management of patients who are being evaluated for

malignancy in bile duct strictures.

PMID: 15330900

Does seeing the full abstract make more sense to you? At least this

explains what FISH stands for ... fluorescence in situ

hybridization ... and that it looks for chromosomal abnormalities

related to malignancies [which you knew already].

I think the " sensitivity " value of 23% means that the technique will

give false-negatives 77% of the time .... in other words the

technique is not very sensitive and will miss 3 out 4 malignancies.

I think that the " specificity " value of 91% means that it is

specific 91% of the time [in other words it will give a false-

positive 1 out 10 times]. I am hoping and praying that you will be

this 1 in 10.

Please, please, if anyone in the group has a different take on what

these numbers mean, don't hesitate to post this information.

If you would like the full paper, just let me know and I'll send it

to you privately.

Best regards,

Dave

(father of (19); PSC 07/03; UC 08/03)

> can someone interpret this for me:

>

> The sensitivity of FISH for the bile aspirate specimens was 23%,

and the

> combined sensitivity of FISH for aspirate and brushing specimens

was 35%. The

> specificity of FISH and cytology brushings were 91% and 98% (p=

0.06),

> respectively.

>

>

> I went to Mayo again last week for another ERCP and got results

today.

> Apparently everything is good except the FISH test which shows

abnormal

> chromasomes. Now they want me back ASAP for an MRI. I asked the

doctor about

> cancer and she said it might not yet be cancer but clearly she

thinks it is.

> She said even if the tests are negative they will probalby want to

transplant

> me anyway. I pray to God this isnt cancer. Right now Im scared to

death.

>

> I watched my mom die of Pancreatic cancer just a few weeks ago and

I really dont

> want to die. As im sure i mentioned before i have a 3yr old

little boy and a

> 1yr old little girl. All I care about is being around to watch

them grow up.

> Its just not a good time for this to happen. Any help on the

stuff above would

> be great.

>

> Thanks to everyone.

>

> Mark

[Guest guest]

Thanks . I knew you would have the answer.

From: Sent: Monday, October 25, 2004 7:15 PMTo: Subject: Re: I need some interpretation

Dear Mark;The sentence you want interpreting is taken from the following abstract:Am J Gastroenterol. 2004 Sep;99(9):1675-81.A comparison of routine cytology and fluorescence in situ hybridization for the detection of malignant bile duct strictures.Kipp BR, Stadheim LM, Halling SA, Pochron NL, Harmsen S, Nagorney DM, Sebo TJ, Therneau TM, Gores GJ, de Groen PC, Baron TH, Levy MJ, Halling KC, LR.Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.BACKGROUND AND AIM: The aim of this study was to assess the relative sensitivities and specificities of fluorescence in situ hybridization (FISH) and routine cytology for the detection of malignancy in biliary tract strictures. METHODS: Bile duct brushing and aspirate specimens were collected from 131 patients being evaluated for possible malignant bile duct strictures. Both specimen types were assessed by FISH but only brushing specimens were assessed by cytology. The FISH assay used a mixture of fluorescently-labeled probes to the centromeres of chromosomes 3, 7, and 17 and chromosomal band 9p21 (Vysis UroVysion) to identify cells having chromosomal abnormalities. A case was considered positive for malignancy if five or more cells exhibited polysomy. RESULTS: Sixty-six of the 131 patients had surgical pathologic and/or clinical evidence of malignancy. Thirty-nine patients had cholangiocarcinoma, 19 had pancreatic carcinoma, and 8 had other types of malignancy. The sensitivity of cytology and FISH for the detection of malignancy in bile duct brushing specimens in these patients was 15% and 34% (p < 0.01), respectively. The sensitivity of FISH for the bile aspirate specimens was 23%, and the combined sensitivity of FISH for aspirate and brushing specimens was 35%. The specificity of FISH and cytology brushings were 91% and 98% (p= 0.06), respectively. CONCLUSIONS: FISH is significantly more sensitive than and nearly as specific as conventional cytology for the detection of malignant biliary strictures in biliary brushing specimens. FISH may improve the clinical management of patients who are being evaluated for malignancy in bile duct strictures.PMID: 15330900Does seeing the full abstract make more sense to you? At least this explains what FISH stands for ... fluorescence in situ hybridization ... and that it looks for chromosomal abnormalities related to malignancies [which you knew already]. I think the "sensitivity" value of 23% means that the technique will give false-negatives 77% of the time .... in other words the technique is not very sensitive and will miss 3 out 4 malignancies. I think that the "specificity" value of 91% means that it is specific 91% of the time [in other words it will give a false-positive 1 out 10 times]. I am hoping and praying that you will be this 1 in 10.Please, please, if anyone in the group has a different take on what these numbers mean, don't hesitate to post this information. If you would like the full paper, just let me know and I'll send it to you privately. Best regards,Dave (father of (19); PSC 07/03; UC 08/03)> can someone interpret this for me:> > The sensitivity of FISH for the bile aspirate specimens was 23%, and the> combined sensitivity of FISH for aspirate and brushing specimens was 35%. The> specificity of FISH and cytology brushings were 91% and 98% (p= 0.06),> respectively.> > > I went to Mayo again last week for another ERCP and got results today. > Apparently everything is good except the FISH test which shows abnormal> chromasomes. Now they want me back ASAP for an MRI. I asked the doctor about> cancer and she said it might not yet be cancer but clearly she thinks it is. > She said even if the tests are negative they will probalby want to transplant> me anyway. I pray to God this isnt cancer. Right now Im scared to death.> > I watched my mom die of Pancreatic cancer just a few weeks ago and I really dont> want to die. As im sure i mentioned before i have a 3yr old little boy and a> 1yr old little girl. All I care about is being around to watch them grow up. > Its just not a good time for this to happen. Any help on the stuff above would> be great. > > Thanks to everyone.> > Mark

[Guest guest]

Dear Mark;

I'd like to apologize for not replying fully to your message of

yesterday ... I guess I was in a bit of a hurry to get you an answer

to your interpretation question.

My dad died of pancreatic cancer several years ago, and so I can

definitely relate to what you are going through with your mom passing

away from this disease .... please accept my deepest sympathies on

your loss.

On the " FISH " results I can imagine that you must be very anguished

by this, but as your doctor said it's not a certainty that this means

cancer. So try to think positive and wait for the MRI results; we'll

be thinking of you and hoping and praying for a good outcome. You

should be encouraged by the fact that everything else looks good, and

that if they do move you to early transplant you will have a great

chance of a rapid recovery.

All the best,

Dave

(father of (19); PSC 07/03; UC 08/03)

> Thanks . I knew you would have the answer.

>