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Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is commonly performed to diagnose and stage a variety of gastrointestinal, hepatobiliary, and even pulmonary or mediastinal malignancies. Although conventional cytology is traditionally used to diagnose malignancy, its accuracy is relatively low. Two technologies — digital image analysis (DIA) and fluorescence in-situ hybridization (FISH) — have been shown to yield greater diagnostic accuracy for malignancy than cytology in analysis of specimens obtained from biliary strictures at the time of endoscopic retrograde cholangiopancreatography (Clin Gastroenterol Hepatol 2004; 2:214 and Gastrointest Endosc 2012; 75:65). However, these techniques have not been well studied as an adjunc…