title: Predictors for detection of cancer in patients with indeterminate biliary stricture and atypical cells on endoscopic retrograde brush cytology.
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.
  
  
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Tavankit
authors.initials: T
authors.lastname: Singh
authors.forename: Norma G
authors.initials: NG
authors.lastname: Gutierrez
authors.forename: Ramprasad
authors.initials: R
authors.lastname: Jegadeesan
authors.forename: Preethi G
authors.initials: PG
authors.lastname: Venkatesh
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brainard
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
mesh_terms: D000368:Aged; D000428:Alcohol Drinking; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology*; D001706:Biopsy / Q000379:methods; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000000981:diagnostic imaging / Q000473:pathology*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005820:Genetic Testing; D006801:Humans; D007565:Jaundice / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; C578959:carbohydrate antigen 199, human
keywords: atypical cell; cholangiocarcinoma; endoscopic retrograde cholangiopancreatography; primary sclerosing cholangitis