We thank the editors for giving us an opportunity to comment on Dr Cote’s excellent summary of our paper. We largely agree with his analysis and most of his conclusions regarding our data. He highlights the difficulty that we encounter when confronted with this most challenging group of patients, those with indeterminate biliary strictures. After decades of image analysis of cytologic and histologic samples, our colleagues in pathology have come up with a grading system that results in final reads which should have no false positives with positive predictive values and specificity of 100%.