Clinical Endoscopy

Factors Associated with Malignant Biliary Strictures in Patients with Atypical or Suspicious Cells on Brush Cytology: Ji Young Park, Tae Joo Jeon; Clin Endosc 2019;52(2):168-174. Published online January 9, 2019; DOI: https://doi.org/10.5946/ce.2018.105

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.

Citations

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Risk of Malignancy for Indeterminate Cytology of Bile Duct Strictures: A Systematic Review and Meta-analysis
Kayla R. Lieb, Zachary E. Williams, Harlan Sayles, Muizz Zaman, Mashaal Dhir
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Kang Ho Lee, Gwang Hyo Yim, Jimin Han, Han Taek Jeong
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High Diagnostic Yield of Endoscopic Retrograde Cholangiopancreatography Brush Cytology for Indeterminate Strictures
Abdulsemed M Nur, Misbah Salim, Scott Boerner, Suqing Li, Cindy C Y Law, Leanne Edwards, Kaitlin Ryan, Paul D James
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Giovanna Del Vecchio Blanco, Michelangela Mossa, Edoardo Troncone, Renato Argirò, Andrea Anderloni, Alessandro Repici, Omero Alessandro Paoluzi, Giovanni Monteleone
World Journal of Gastrointestinal Endoscopy.2021; 13(10): 473. CrossRef
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A Case of Pancreatic Intraepithelial Neoplasia Presenting as Aucte Pancreatitis: Dong Wook Lee, M.D., Jae Kwon Jung, M.D., Dong Yeub Eun, M.D., Jung Soo Lee, M.D., Jae Kwang Lee, M.D., Sang Man Park, M.D., Hyun Soo Kim, M.D. and Mi Jin Gu, M.D.*; Korean J Gastrointest Endosc 2010;40(1):62-67. Published online January 30, 2010

Abstract PDF: Pancreatic intraepithelial neoplasia (PanIN) is a precancerous lesion. A 72-year old man was admitted to our hospital because of abdominal pain, and he had an elevated serum level of pancreatic amylase. ERCP showed a focal stricture of the main pancreatic duct without upstream dilatation in the body of the pancreas. Cytologic evaluation with an endoscopic brush at the stricture suggested the presence of adenocarcinoma. After subtotal pancreatectomy, the features of PanIN were observed in the branch pancreatic duct. ERCP with brush cytology seems to be a useful method for detecting PanIN at the precancerous stage. We report here on a case of PanIN associated with a stricture of the main pancreatic duct. (Korean J Gastrointest Endosc 2010;40:62-67)

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악성 담도협착증에서 내시경적 쇄자세포진 검사의 진단적 유용성 ( Usefulness of Endoscopic Brush Cytology from malignant Biliary Obstruction ): Korean J Gastrointest Endosc 2001;23(3):159-163. Published online November 30, 2000

Abstract PDF: Background
s/Aims: In patients with obstructive jaundice due to malignant biliary tract stricture, a tissue diagnosis is essential because the various treatment options are available. The tissue biopsy form the biliary tree is difficult because of the focal, sclerotic, small annular nature and lower celluarity. Brush cytology is and effective method for obtaining a tissue from bile duct stricture, and the diagnostic sensitivity of endoscopic brush cytology is reported as between 40% and 70% form malignant bile duct strictures. In this study, we analyzed the diagnostic value of endoscopic brush cytology in patient with extrahepatic bile duct strictures. Methods: The eight patients with extrahepatic bile duct strictures diagnosed with endoscopic retrograde cholangiopancretography underwent endoscopic brush cytology and aspiration bile cytology. Brushing were taken using a Greenen cytology brush passed with a guide wire through the stricture. Results: The final diagnoses were made by surgical pathology and clinical follow-up. The sensitivity of brush cytology (62.5%, 5/8) was significantly higher than the sensitivity of bile cytology (0%; 0/8). No procedure related complication occurred. Conclusions: Endoscopic brush cytology would be an effective and a relatively safe method for tissue diagnosis in patients with malignant biliary obstruction.

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