The Significance of p53 and K-ras Immunocytochemical Staining in the Diagnosis of Malignant Biliary Obstruction by Brush Cytology during ERCP.
- Author:
Young Sup KIM
1
;
Ho Gak KIM
;
Jimin HAN
;
Change Jae HUR
;
Byeong Suk KIM
;
Jin Tae JUNG
;
Joong Goo KWON
;
Eun Young KIM
;
Chang Ho CHO
;
Yoon Kyung SOHN
Author Information
1. Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. hgkim@cu.ac.kr
- Publication Type:Original Article
- Keywords:
Malignant biliary obstruction;
Brush cytology;
ERCP;
Immunocytochemical stain
- MeSH:
Cholangiopancreatography, Endoscopic Retrograde;
Common Bile Duct;
Hepatic Duct, Common;
Humans;
Pancreatic Neoplasms;
Sensitivity and Specificity
- From:Gut and Liver
2010;4(2):219-225
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Brush cytology during ERCP can provide a pathologic diagnosis in malignant biliary obstruction. K-ras and p53 mutations are commonly found in biliary and pancreatic cancers. We evaluated the diagnostic yield of brush cytology and the changes obtained by adding p53 and K-ras staining. METHODS: One hundred and forty patients with biliary obstruction who underwent ERCP with brush cytology during a 7-year period were included. The sensitivity and specificity of brush cytology only and with the addition of p53 and K-ras staining were obtained. RESULTS: Malignant biliary obstruction was confirmed in 119 patients. The sensitivity and specificity of brush cytology were 78.2% and 90.5%, respectively. The sensitivity of cytology was 77.3% at the ampulla-distal common bile duct (CBD), 92.6% at the mid common hepatic duct (CHD), and 94.7% at the proximal CBD-CHD (p<0.05); these values did not differ with the degree or the length of the obstruction. In the 97 patients who received additional p53 and K-ras staining, the sensitivity of cytology plus p53 was 88.2%, cytology plus K-ras was 84.0%, and cytology plus p53 and K-ras was 88.2%. The sensitivity of cytology plus p53 was higher than that of brush cytology only (95% confidence interval: 83.69-92.78 vs 72.65-83.65) but not that of cytology plus K-ras. CONCLUSIONS: Brush cytology for malignant biliary obstruction has a high diagnostic accuracy. Adding p53 staining can further improve the diagnostic yield, whereas K-ras staining does not.
