Role of fluorescence in situ hybridization in the diagnosis of malignant biliary stricture

Introduction: Biliary stricture is a fixed narrowing of a focal segment of the bile duct that result in proximal biliary dilatation and clinical features of obstructive jaundice. A wide spectrum of hepatobiliary and pancreatic diseases, both benign and malignant, can result in the development of biliary strictures. Although trans abdominal ultrasound, computed tomography, and magnetic resonance imaging are sensitive for detecting bile duct pathology, they do not reliably distinguish strictures as being malignant or benign. FISH utilizes fluorescently labeled DNA probes to chromosomal centromeres or unique loci to detect cells that have numerical or structural abnormalities indicative of malignancy

Aim of the study: To evaluate the accuracy of FISH in the diagnosis of malignant biliary stricture

Patient and methods: Forty eight patients with indeterminate bile duct stricture presented with obstructive jaundice were prospectively enrolled and underwent ERCP and FISH over a period of 20 month from June 2013 to February 2015. Four patients were excluded because of loss follow-up. Thus, 44 patients were included in data analysis [17 males and 27 females]

Results: The final diagnosis of stricture type was 32 malignant and 12 benign cases. FISH was positive in 30 cases and negative in 14 cases, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 93.75, 100.00, 100.0, 85.7, 95.5 and 0.969 respectively

Conclusion: FISH increase the diagnostic accuracy of malignant biliary stricture. The sensitivity of FISH could improve the clinical management of patients being evaluated for malignant bile duct stricture by enabling a definitive diagnosis at an earlier stage in the clinical evaluation

Spontaneous viral clearance of chronic HCV infection in Upper Egypt: a community-based study with a 10 year follow-up

Hepatitis C virus [HCV] infection is a global blood-borne disease with the highest prevalence in Egypt. The natural course of HCV infections in highly variable. The reason why the infection persists in some patients and resolves spontaneously in others is not known. The aim of this study was to detect the frequency of spontaneous clearance of chronic HCV infection in Upper Egypt and to determine the predictors of persistence of HCV infection. In 1997, a community-based study was performed in Sallam village in Upper Egypt. Out of the 329 patients who had the start of the study and those who had received specific treatment for HCV infection. These patients were followed up every six months prospectively starting from 2004 till 2007 by clinical, ultrasonographic, and laboratory examinations [liver functions, complete blood count, prothrombin time and concentration]. Serum HCV-RNA was tested for at the end of the follow up period. After a 10-year follow-up, spontaneous clearance of chronic HCV infection was detected in 35 [17.5%] out of 200 patients. Most of clinical and laboratory abnormalities were detected in patients with HCV-RNA persistence than those who had cleared HCV-RNA. By ultrasonographic examination, normal liver echopattern was found in 30 [85.7%] cases with HCV-RNA clearance and in75 [45.5%] patients who had HCV-RNA persistence. Evidence of liver cirrhosis was found only in 9 cases with HCV-RNA persistence [5.5%]. Old age [>60 years] was the strongest predictor of persistence of HCV infection followed by obesity and history of blood transfusion. Spontaneous clearance of chronic HCV infection could occur without any specific antiviral therapy in 17.5% of patients. Older age was the strongest predictor of persistence of HCV infection followed by obesity and infection by blood transfusion