Prospective Study of Biliary Strictures to Determine the Predictors of Malignancy

Abstract

A serum bilirubin level of 75 micromol/L or higher, or a stricture length of greater than 14 mm was highly predictive of malignancy in patients with a biliary stricture. Ultrasound was useful in predicting malignant strictures by detecting either intrahepatic duct dilation or by visualizing the tumour (primary or metastases). Strictures with a 'benign' cholangiographic appearance are frequently malignant. Disida scan did not add additional information. ERCP is necessary to diagnose benign strictures, which tend to be less extensive at presentation.

Bilirubin levels predict malignancy in patients with obstructive jaundice

“…Previous studies have also found bilirubin to predict malignancy with AUC values of 0.8 5 and quoted bilirubin levels of 84 mmol/l (sensitivity and specificity of 98.6% and 59.3%, respectively) and 75 mmol/l. 6,7 These values are commensurate with the results from the current data. A previous study has reported that patients presenting with malignant obstructive jaundice have a median bilirubin level of 160 mmol/l and that only 23% of patients have a bilirubin level <100 mmol/l and a rate of rise of bilirubin of 100 mmol/l per week.…”

Role of biliary tract cytology in the evaluation of extrahepatic cholestatic jaundice

“…[5] In the present study, serum bilirubin levels were significantly elevated in malignant group; however, elevation in liver enzymes was statistically not significant. Mansfield et al .…”

“…The threshold values of liver function tests used for comparison between positive and negative for malignancy were as follows-serum bilirubin (75μmol/L = 4.5 mg/dL); alanine transaminase (ALT) (100 U/L); aspartate transaminase (AST) (150U/L) and alkaline phosphatase (ALP) (400 U/L). [5] Statistical analysis was carried out using the SPSS17.0 version and results were compared between groups using χ 2 test wherever required.…”

“…[1] In addition to establishing an accurate anatomic diagnosis, it provides an etiological diagnosis with cytologic methods for evaluating biliary ductal epithelium by brushings and direct examination of bile and therapeutic biliary stenting to relieve symptoms of obstruction. [45]…”

Stone or stricture: does the calibre of intrahepatic bile ducts predict the diagnosis?

“…In the literature, we found no earlier studies on the role of intrahepatic bile ducts in this differential diagnosis, but we did found two studies which had been designed to compare the occurrence of intrahepatic bile duct dilatation between patients with malignant and benign bile duct strictures 3,4 . In these studies, intrahepatic bile duct dilatation was more frequently ( P = 0.002, P < 0.0001; subsequently) encountered in malignant biliary strictures (93%, 74%; subsequently) compared with benign biliary strictures (36%, 40%; subsequently).…”