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Predictors for detection of cancer in patients with indeterminate biliary stricture and atypical cells on endoscopic retrograde brush cytology
Author(s) -
Navaneethan Udayakumar,
Singh Tavankit,
Gutierrez Norma G,
Jegadeesan Ramprasad,
Venkatesh Preethi G,
Brainard Jennifer,
Vargo John J,
Parsi Mansour A
Publication year - 2014
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12134
Subject(s) - medicine , cytology , hazard ratio , gastroenterology , jaundice , pancreatic cancer , cancer , gallbladder cancer , carcinoma , proportional hazards model , endoscopic retrograde cholangiopancreatography , pathology , confidence interval , pancreatitis
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. 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 K aplan– M eier estimates for detecting cancer. 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 ( CA 19‐9) 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. 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 .