Clin Endosc.  2019 Mar;52(2):168-174. 10.5946/ce.2018.105.

Factors Associated with Malignant Biliary Strictures in Patients with Atypical or Suspicious Cells on Brush Cytology

• Park JY
• Jeon TJ

• KMID: 2447674
• DOI: http://doi.org/10.5946/ce.2018.105

Abstract

BACKGROUND/AIMS
Pathological diagnosis of biliary strictures with atypical or suspicious cells on endoscopic retrograde brush cytology and indeterminate strictures on imaging is challenging. The aim of this study was to identify markers for malignant strictures in such cases.
METHODS
We retrospectively analyzed data collected from 146 consecutive patients with indeterminate biliary strictures on imaging who underwent endoscopic retrograde brush cytology from 2007 to 2013. Factors associated with malignant strictures in patients with atypical 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 ampulla of Vater cancer, and 3 other types), 36 (53.7%) had atypical or suspicious cells on brush cytology. Among these, the factors that independently 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 patients with indeterminate biliary strictures on imaging and atypical or suspicious cells on brush cytology.

Keyword

Brush cytology; Biliary stricture; Atypical cell; Suspicious cell

MeSH Terms

Alkaline Phosphatase
Ampulla of Vater
Carcinoembryonic Antigen
Cholangiocarcinoma
Constriction, Pathologic*
Diagnosis
Gallbladder Neoplasms
gamma-Glutamyltransferase
Humans
Pancreatic Neoplasms
Retrospective Studies
Alkaline Phosphatase
Carcinoembryonic Antigen
gamma-Glutamyltransferase

Figure

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  Fig. 1. Receiver operator curves and corresponding area under curves for carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (rGT) and length of stricture.

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