Re: caliber prominence perihilar/Lori

[Guest guest]

Lori,

apologies if this is a double post.

I have/had a hilar stricture but no evidence of CCA. The hilar region is the

junction

of the left and right hepatic ducts as they join and exit the liver parenchyma,

as you probably know.

Your report is pretty cryptic, but what I THINK it means is that the

intrahepatic

ducts in the left lobe are enlarged, due to bile backed up above a stricture. A

similar MRCP report (more clearly worded) led to the conclusion that I had a

stricture. So they will probably want to do ERCP to open the strictures and get

brushings.

I was suspicious of the stricture because of the location, which is indeed where

a lot of CCAs show up. But the biopsies, MRCP, CT, ultrasounds and the view

from the spy scope don't show anything to increase the suspicion of CCA and

my doctor is pretty convinced it isn't CCA causing the stricture. So don't jump

to the worst conclusion. I think cancers grow there particularly because it is a

point susceptible to inflammation, so most likely it's just evidence that there

is

inflammation at that point. Why it's susceptible I'm not sure; I sort of imagine

the

turblulence when two large rivers join and figure that's where irritating

bits of flotsam get stuck.

Good luck to you and your wild crew.

Martha (MA)

> caliber prominence to the perihilar intrahepatic biliary tree

> particularly in the left lobe of the liver

> liver is enlarged (doesn't say how big)

>

> when you google perihilar intrahepatic biliary- you get a lot of info

> on chiolagiocarcinoma or bile duct cancer so I am worried about what

> the MRCP means

>

[Guest guest]

Lori,

apologies if this is a double post.

I have/had a hilar stricture but no evidence of CCA. The hilar region is the

junction

of the left and right hepatic ducts as they join and exit the liver parenchyma,

as you probably know.

Your report is pretty cryptic, but what I THINK it means is that the

intrahepatic

ducts in the left lobe are enlarged, due to bile backed up above a stricture. A

similar MRCP report (more clearly worded) led to the conclusion that I had a

stricture. So they will probably want to do ERCP to open the strictures and get

brushings.

I was suspicious of the stricture because of the location, which is indeed where

a lot of CCAs show up. But the biopsies, MRCP, CT, ultrasounds and the view

from the spy scope don't show anything to increase the suspicion of CCA and

my doctor is pretty convinced it isn't CCA causing the stricture. So don't jump

to the worst conclusion. I think cancers grow there particularly because it is a

point susceptible to inflammation, so most likely it's just evidence that there

is

inflammation at that point. Why it's susceptible I'm not sure; I sort of imagine

the

turblulence when two large rivers join and figure that's where irritating

bits of flotsam get stuck.

Good luck to you and your wild crew.

Martha (MA)

> caliber prominence to the perihilar intrahepatic biliary tree

> particularly in the left lobe of the liver

> liver is enlarged (doesn't say how big)

>

> when you google perihilar intrahepatic biliary- you get a lot of info

> on chiolagiocarcinoma or bile duct cancer so I am worried about what

> the MRCP means

>

[Guest guest]

Lori,

apologies if this is a double post.

I have/had a hilar stricture but no evidence of CCA. The hilar region is the

junction

of the left and right hepatic ducts as they join and exit the liver parenchyma,

as you probably know.

Your report is pretty cryptic, but what I THINK it means is that the

intrahepatic

ducts in the left lobe are enlarged, due to bile backed up above a stricture. A

similar MRCP report (more clearly worded) led to the conclusion that I had a

stricture. So they will probably want to do ERCP to open the strictures and get

brushings.

I was suspicious of the stricture because of the location, which is indeed where

a lot of CCAs show up. But the biopsies, MRCP, CT, ultrasounds and the view

from the spy scope don't show anything to increase the suspicion of CCA and

my doctor is pretty convinced it isn't CCA causing the stricture. So don't jump

to the worst conclusion. I think cancers grow there particularly because it is a

point susceptible to inflammation, so most likely it's just evidence that there

is

inflammation at that point. Why it's susceptible I'm not sure; I sort of imagine

the

turblulence when two large rivers join and figure that's where irritating

bits of flotsam get stuck.

Good luck to you and your wild crew.

Martha (MA)

> caliber prominence to the perihilar intrahepatic biliary tree

> particularly in the left lobe of the liver

> liver is enlarged (doesn't say how big)

>

> when you google perihilar intrahepatic biliary- you get a lot of info

> on chiolagiocarcinoma or bile duct cancer so I am worried about what

> the MRCP means

>

[Guest guest]

Martha,

I also had a stricture show up at the Hilum extending into the left hepatic

duct. They took

brushings and 6 biopsy cuts from the area. the results showed displasia but no

CCA. My

tumor markers are normal. However they also took samples for FISH (Fluorensent

In situ

Hybridization) which showed Chromosome changes which they are very concerned

about.

This test showed that I had severe chromosome changes, because of this result

they feel I

have CCA which is being missed by other methods. This test is very new however

and I'm

not sure what to think about it. Any thoughts? I had this test at Mayo MN. I

believe they

are the only ones doing it.

/New York

> > caliber prominence to the perihilar intrahepatic biliary tree

> > particularly in the left lobe of the liver

> > liver is enlarged (doesn't say how big)

> >

> > when you google perihilar intrahepatic biliary- you get a lot of info

> > on chiolagiocarcinoma or bile duct cancer so I am worried about what

> > the MRCP means

> >

>

[Guest guest]

Martha,

I also had a stricture show up at the Hilum extending into the left hepatic

duct. They took

brushings and 6 biopsy cuts from the area. the results showed displasia but no

CCA. My

tumor markers are normal. However they also took samples for FISH (Fluorensent

In situ

Hybridization) which showed Chromosome changes which they are very concerned

about.

This test showed that I had severe chromosome changes, because of this result

they feel I

have CCA which is being missed by other methods. This test is very new however

and I'm

not sure what to think about it. Any thoughts? I had this test at Mayo MN. I

believe they

are the only ones doing it.

/New York

> > caliber prominence to the perihilar intrahepatic biliary tree

> > particularly in the left lobe of the liver

> > liver is enlarged (doesn't say how big)

> >

> > when you google perihilar intrahepatic biliary- you get a lot of info

> > on chiolagiocarcinoma or bile duct cancer so I am worried about what

> > the MRCP means

> >

>

[Guest guest]

Martha,

I also had a stricture show up at the Hilum extending into the left hepatic

duct. They took

brushings and 6 biopsy cuts from the area. the results showed displasia but no

CCA. My

tumor markers are normal. However they also took samples for FISH (Fluorensent

In situ

Hybridization) which showed Chromosome changes which they are very concerned

about.

This test showed that I had severe chromosome changes, because of this result

they feel I

have CCA which is being missed by other methods. This test is very new however

and I'm

not sure what to think about it. Any thoughts? I had this test at Mayo MN. I

believe they

are the only ones doing it.

/New York

> > caliber prominence to the perihilar intrahepatic biliary tree

> > particularly in the left lobe of the liver

> > liver is enlarged (doesn't say how big)

> >

> > when you google perihilar intrahepatic biliary- you get a lot of info

> > on chiolagiocarcinoma or bile duct cancer so I am worried about what

> > the MRCP means

> >

>

[Guest guest]

,

In your shoes, I'd put myself in Dr. Gore's hands at Mayo,

exactly as you have done. That's what I was planning if this

last ERCP hadn't gone better than previous ones. I tried last

December to have brushings sent to Mayo for FISH, but there

was not enough material for them to do it. According to

this paper, FISH is twice as sensitive and nearly as specific

(basically, the false positive rate is nearly as low) as for

conventional cytology. I wish that we had sent them the brushings

for my last ERCP but my doc was reluctant after the last

disappointment. But my stricture doesn't look or behave like CCA,

so my worries are somewhat relieved. Are you now being evaluated

for cancer treatment and transplant?

Martha (MA)

Gastroenterology. 2006 Oct;131(4):1064-72. Epub 2006 Aug 16.

Advanced cytologic techniques for the detection of malignant

pancreatobiliary strictures.

* Moreno Luna LE,

* Kipp B,

* Halling KC,

* Sebo TJ,

* Kremers WK,

* LR,

* Barr Fritcher EG,

* Levy MJ,

* Gores GJ.

Division of Gastroenterology and Hepatology, Mayo Clinic College

of Medicine, Rochester, Minnesota, USA.

Background & Aims: Two advanced cytologic techniques for detecting

aneuploidy-digital image analysis (DIA) and fluorescence in situ

hybridization (FISH)-have recently been developed to help identify

malignant pancreatobiliary strictures. The aim of this study was to

assess the clinical utility of cytology, DIA, and FISH for the

identification of malignant pancreatobiliary strictures. Methods:

Brush cytologic specimens from 233 consecutive patients undergoing

endoscopic retrograde cholangiopancreatography for pancreatobiliary

strictures were examined by all 3 (cytology, DIA, and FISH)

techniques. Strictures were stratified as proximal (n = 33) or distal

(n = 114) based on whether they occurred above or below the cystic

duct, respectively. Strictures in patients with primary sclerosing

cholangitis (n = 86) were analyzed separately. Results: Despite the

stratification, the performances of the tests were similar.

Conventional cytology has a low sensitivity (4%-20%) but 100%

specificity. Because of the high specificity for cytology, we assessed

the performance of the other tests when conventional cytology was

negative. In this clinical context, FISH had an increased sensitivity

(35%-60%) when assessing for chromosomal gains (polysomy) while

preserving the specificity of cytology. The sensitivity and

specificity of DIA was intermediate as compared with routine cytology

and FISH but was additive to FISH values demonstrating only trisomy of

chromosome 7 or chromosome 3. Conclusions: These findings suggest that

FISH and DIA increase the sensitivity for the diagnosis of malignant

pancreatobiliary tract strictures over that obtained by conventional

cytology while maintaining an acceptable specificity.

>

> Martha,

>

> I also had a stricture show up at the Hilum extending into the left

hepatic duct. They took

> brushings and 6 biopsy cuts from the area. the results showed

displasia but no CCA. My

> tumor markers are normal. However they also took samples for FISH

(Fluorensent In situ

> Hybridization) which showed Chromosome changes which they are very

concerned about.

> This test showed that I had severe chromosome changes, because of

this result they feel I

> have CCA which is being missed by other methods. This test is very

new however and I'm

> not sure what to think about it. Any thoughts? I had this test at

Mayo MN. I believe they

> are the only ones doing it.

>

> /New York

[Guest guest]

,

In your shoes, I'd put myself in Dr. Gore's hands at Mayo,

exactly as you have done. That's what I was planning if this

last ERCP hadn't gone better than previous ones. I tried last

December to have brushings sent to Mayo for FISH, but there

was not enough material for them to do it. According to

this paper, FISH is twice as sensitive and nearly as specific

(basically, the false positive rate is nearly as low) as for

conventional cytology. I wish that we had sent them the brushings

for my last ERCP but my doc was reluctant after the last

disappointment. But my stricture doesn't look or behave like CCA,

so my worries are somewhat relieved. Are you now being evaluated

for cancer treatment and transplant?

Martha (MA)

Gastroenterology. 2006 Oct;131(4):1064-72. Epub 2006 Aug 16.

Advanced cytologic techniques for the detection of malignant

pancreatobiliary strictures.

* Moreno Luna LE,

* Kipp B,

* Halling KC,

* Sebo TJ,

* Kremers WK,

* LR,

* Barr Fritcher EG,

* Levy MJ,

* Gores GJ.

Division of Gastroenterology and Hepatology, Mayo Clinic College

of Medicine, Rochester, Minnesota, USA.

Background & Aims: Two advanced cytologic techniques for detecting

aneuploidy-digital image analysis (DIA) and fluorescence in situ

hybridization (FISH)-have recently been developed to help identify

malignant pancreatobiliary strictures. The aim of this study was to

assess the clinical utility of cytology, DIA, and FISH for the

identification of malignant pancreatobiliary strictures. Methods:

Brush cytologic specimens from 233 consecutive patients undergoing

endoscopic retrograde cholangiopancreatography for pancreatobiliary

strictures were examined by all 3 (cytology, DIA, and FISH)

techniques. Strictures were stratified as proximal (n = 33) or distal

(n = 114) based on whether they occurred above or below the cystic

duct, respectively. Strictures in patients with primary sclerosing

cholangitis (n = 86) were analyzed separately. Results: Despite the

stratification, the performances of the tests were similar.

Conventional cytology has a low sensitivity (4%-20%) but 100%

specificity. Because of the high specificity for cytology, we assessed

the performance of the other tests when conventional cytology was

negative. In this clinical context, FISH had an increased sensitivity

(35%-60%) when assessing for chromosomal gains (polysomy) while

preserving the specificity of cytology. The sensitivity and

specificity of DIA was intermediate as compared with routine cytology

and FISH but was additive to FISH values demonstrating only trisomy of

chromosome 7 or chromosome 3. Conclusions: These findings suggest that

FISH and DIA increase the sensitivity for the diagnosis of malignant

pancreatobiliary tract strictures over that obtained by conventional

cytology while maintaining an acceptable specificity.

>

> Martha,

>

> I also had a stricture show up at the Hilum extending into the left

hepatic duct. They took

> brushings and 6 biopsy cuts from the area. the results showed

displasia but no CCA. My

> tumor markers are normal. However they also took samples for FISH

(Fluorensent In situ

> Hybridization) which showed Chromosome changes which they are very

concerned about.

> This test showed that I had severe chromosome changes, because of

this result they feel I

> have CCA which is being missed by other methods. This test is very

new however and I'm

> not sure what to think about it. Any thoughts? I had this test at

Mayo MN. I believe they

> are the only ones doing it.

>

> /New York

[Guest guest]

,

In your shoes, I'd put myself in Dr. Gore's hands at Mayo,

exactly as you have done. That's what I was planning if this

last ERCP hadn't gone better than previous ones. I tried last

December to have brushings sent to Mayo for FISH, but there

was not enough material for them to do it. According to

this paper, FISH is twice as sensitive and nearly as specific

(basically, the false positive rate is nearly as low) as for

conventional cytology. I wish that we had sent them the brushings

for my last ERCP but my doc was reluctant after the last

disappointment. But my stricture doesn't look or behave like CCA,

so my worries are somewhat relieved. Are you now being evaluated

for cancer treatment and transplant?

Martha (MA)

Gastroenterology. 2006 Oct;131(4):1064-72. Epub 2006 Aug 16.

Advanced cytologic techniques for the detection of malignant

pancreatobiliary strictures.

* Moreno Luna LE,

* Kipp B,

* Halling KC,

* Sebo TJ,

* Kremers WK,

* LR,

* Barr Fritcher EG,

* Levy MJ,

* Gores GJ.

Division of Gastroenterology and Hepatology, Mayo Clinic College

of Medicine, Rochester, Minnesota, USA.

Background & Aims: Two advanced cytologic techniques for detecting

aneuploidy-digital image analysis (DIA) and fluorescence in situ

hybridization (FISH)-have recently been developed to help identify

malignant pancreatobiliary strictures. The aim of this study was to

assess the clinical utility of cytology, DIA, and FISH for the

identification of malignant pancreatobiliary strictures. Methods:

Brush cytologic specimens from 233 consecutive patients undergoing

endoscopic retrograde cholangiopancreatography for pancreatobiliary

strictures were examined by all 3 (cytology, DIA, and FISH)

techniques. Strictures were stratified as proximal (n = 33) or distal

(n = 114) based on whether they occurred above or below the cystic

duct, respectively. Strictures in patients with primary sclerosing

cholangitis (n = 86) were analyzed separately. Results: Despite the

stratification, the performances of the tests were similar.

Conventional cytology has a low sensitivity (4%-20%) but 100%

specificity. Because of the high specificity for cytology, we assessed

the performance of the other tests when conventional cytology was

negative. In this clinical context, FISH had an increased sensitivity

(35%-60%) when assessing for chromosomal gains (polysomy) while

preserving the specificity of cytology. The sensitivity and

specificity of DIA was intermediate as compared with routine cytology

and FISH but was additive to FISH values demonstrating only trisomy of

chromosome 7 or chromosome 3. Conclusions: These findings suggest that

FISH and DIA increase the sensitivity for the diagnosis of malignant

pancreatobiliary tract strictures over that obtained by conventional

cytology while maintaining an acceptable specificity.

>

> Martha,

>

> I also had a stricture show up at the Hilum extending into the left

hepatic duct. They took

> brushings and 6 biopsy cuts from the area. the results showed

displasia but no CCA. My

> tumor markers are normal. However they also took samples for FISH

(Fluorensent In situ

> Hybridization) which showed Chromosome changes which they are very

concerned about.

> This test showed that I had severe chromosome changes, because of

this result they feel I

> have CCA which is being missed by other methods. This test is very

new however and I'm

> not sure what to think about it. Any thoughts? I had this test at

Mayo MN. I believe they

> are the only ones doing it.

>

> /New York

[Guest guest]

Yes I am. I had a work up for transplant. SOOOOOO scared. I have

two children that are 5 and 3 and do not want to miss a second of

their lives. Gores and Rosen (transplant surgeon) are not sure what

they want to do with me because the only positive they have is the

FISH. I think they are looking for something to tip the scales.

> >

> > Martha,

> >

> > I also had a stricture show up at the Hilum extending into the

left

> hepatic duct. They took

> > brushings and 6 biopsy cuts from the area. the results showed

> displasia but no CCA. My

> > tumor markers are normal. However they also took samples for FISH

> (Fluorensent In situ

> > Hybridization) which showed Chromosome changes which they are very

> concerned about.

> > This test showed that I had severe chromosome changes, because of

> this result they feel I

> > have CCA which is being missed by other methods. This test is

very

> new however and I'm

> > not sure what to think about it. Any thoughts? I had this test at

> Mayo MN. I believe they

> > are the only ones doing it.

> >

> > /New York

>

[Guest guest]

Yes I am. I had a work up for transplant. SOOOOOO scared. I have

two children that are 5 and 3 and do not want to miss a second of

their lives. Gores and Rosen (transplant surgeon) are not sure what

they want to do with me because the only positive they have is the

FISH. I think they are looking for something to tip the scales.

> >

> > Martha,

> >

> > I also had a stricture show up at the Hilum extending into the

left

> hepatic duct. They took

> > brushings and 6 biopsy cuts from the area. the results showed

> displasia but no CCA. My

> > tumor markers are normal. However they also took samples for FISH

> (Fluorensent In situ

> > Hybridization) which showed Chromosome changes which they are very

> concerned about.

> > This test showed that I had severe chromosome changes, because of

> this result they feel I

> > have CCA which is being missed by other methods. This test is

very

> new however and I'm

> > not sure what to think about it. Any thoughts? I had this test at

> Mayo MN. I believe they

> > are the only ones doing it.

> >

> > /New York

>