Factors Associated with Malignant Biliary Strictures in Patients with Atypical or Suspicious Cells on Brush Cytology
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Background/Aims: Pathological diagnosis of biliary strictures with atypical or suspicious cells on endoscopic retrograde brush cytologyand indeterminate strictures on imaging is challenging. The aim of this study was to identify markers for malignant strictures in suchcases. Methods: We retrospectively analyzed data collected from 146 consecutive patients with indeterminate biliary strictures on imagingwho underwent endoscopic retrograde brush cytology from 2007 to 2013. Factors associated with malignant strictures in patients withatypical or suspicious cells on brush cytology were identified. Results: Among the 67 patients with a malignant disease (48 cholangiocarcinoma, 6 gallbladder cancer, 5 pancreatic cancer, 5 ampullaof Vater cancer, and 3 other types), 36 (53.7%) had atypical or suspicious cells on brush cytology. Among these, the factors thatindependently correlated with malignant strictures were stricture length (odds ratio [OR], 5.259; 95% confidence interval [CI], 1.802–15.294) and elevated carbohydrate antigen 19-9 (CA19-9) (OR, 3.492; 95% CI, 1.242–9.815), carcinoembryonic antigen (CEA) (OR, 4.909;95% CI, 1.694–14.224), alkaline phosphatase (ALP) (OR, 3.362; 95% CI, 1.207–9.361), and gamma-glutamyl transpeptidase (rGT) (OR,4.318; 95% CI, 1.512–12.262). Conclusions: Elevated levels of CA19-9, CEA, ALP, and rGT and stricture length are associated with malignant strictures in patientswith indeterminate biliary strictures on imaging and atypical or suspicious cells on brush cytology.
Abstract
Background/Aims: Pathological diagnosis of biliary strictures with atypical or suspicious cells on endoscopic retrograde brush cytologyand indeterminate strictures on imaging is challenging. The aim of this study was to identify markers for malignant strictures in suchcases. Methods: We retrospectively analyzed data collected from 146 consecutive patients with indeterminate biliary strictures on imagingwho underwent endoscopic retrograde brush cytology from 2007 to 2013. Factors associated with malignant strictures in patients withatypical or suspicious cells on brush cytology were identified. Results: Among the 67 patients with a malignant disease (48 cholangiocarcinoma, 6 gallbladder cancer, 5 pancreatic cancer, 5 ampullaof Vater cancer, and 3 other types), 36 (53.7%) had atypical or suspicious cells on brush cytology. Among these, the factors thatindependently correlated with malignant strictures were stricture length (odds ratio [OR], 5.259; 95% confidence interval [CI], 1.802–15.294) and elevated carbohydrate antigen 19-9 (CA19-9) (OR, 3.492; 95% CI, 1.242–9.815), carcinoembryonic antigen (CEA) (OR, 4.909;95% CI, 1.694–14.224), alkaline phosphatase (ALP) (OR, 3.362; 95% CI, 1.207–9.361), and gamma-glutamyl transpeptidase (rGT) (OR,4.318; 95% CI, 1.512–12.262). Conclusions: Elevated levels of CA19-9, CEA, ALP, and rGT and stricture length are associated with malignant strictures in patientswith indeterminate biliary strictures on imaging and atypical or suspicious cells on brush cytology.
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