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Predictors for detection of cancer in patients with indeterminate biliary stricture and atypical cells on endoscopic retrograde brush cytology.
- Source :
-
Journal of digestive diseases [J Dig Dis] 2014 May; Vol. 15 (5), pp. 268-75. - Publication Year :
- 2014
-
Abstract
- Objective: The management of atypical cells on endoscopic retrograde brush cytology (ERBC) in patients with indeterminate biliary stricture is unclear. This study aimed to investigate the detection of cancer (pancreatic and biliary carcinoma) in patients with atypical cells on ERBC and the factors predicting it.<br />Methods: From a prospectively maintained cytology database in a tertiary care center, patients with indeterminate biliary stricture and atypical cells on ERBC from 1996 to 2012 were studied. The date of the initial ERBC with atypical cells was identified as time zero. The primary outcome was to study the incidences and Kaplan-Meier estimates for detecting cancer.<br />Results: In all, 104 patients with 182.8 person-years of follow-up were identified. In 38 (36.5%) patients cancer was detected (19 cholangiocarcinoma, 15 pancreatic cancer, three ampullary cancer and one gallbladder carcinoma) over a mean follow-up of 4.4 months. On Cox regression analysis, the presence of clinical jaundice (hazard ratio [HR] 4.08, 95% CI 1.41-11.8), active alcohol consumption (HR 7.33, 95% CI 1.85-29.1) and elevated carbohydrate antigen 19-9 (CA19-9) level (>33 U/mL) (HR 8.42, 95% CI 1.75-40.6) at the time of ERBC were associated with increased risk for the detection of cancer. Detection of cancer was more common during the first 6 months of follow-up than at any time period thereafter.<br />Conclusion: Elevated CA19-9 level, the presence of clinical jaundice and current alcohol consumption are associated with increased detection of cancer in patients with indeterminate biliary stricture and atypical cells on ERBC.<br /> (© 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.)
- Subjects :
- Aged
Alcohol Drinking
Antigens, Tumor-Associated, Carbohydrate blood
Bile Duct Neoplasms diagnostic imaging
Bile Ducts, Intrahepatic diagnostic imaging
Biopsy methods
Cholangiocarcinoma diagnostic imaging
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis, Sclerosing diagnostic imaging
Constriction, Pathologic diagnostic imaging
Constriction, Pathologic pathology
Endoscopy, Gastrointestinal
Female
Follow-Up Studies
Genetic Testing
Humans
Jaundice diagnostic imaging
Jaundice pathology
Male
Middle Aged
Pancreatic Neoplasms diagnostic imaging
Proportional Hazards Models
Retrospective Studies
Bile Duct Neoplasms pathology
Bile Ducts, Intrahepatic pathology
Cholangiocarcinoma pathology
Cholangitis, Sclerosing pathology
Pancreatic Neoplasms pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1751-2980
- Volume :
- 15
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of digestive diseases
- Publication Type :
- Academic Journal
- Accession number :
- 24612456
- Full Text :
- https://doi.org/10.1111/1751-2980.12134