A328 FACTORS PREDICTIVE OF MALIGNANCY IN PATIENTS WITH BILIARY BRUSHINGS OBTAINED BY ERCP
Notice bibliographique
Résumé
Abstract Aims Biliary brushings for cytology obtained during endoscopic retrograde cholangiopancreatography (ERCP) are the most commonly used method of evaluating patients with biliary strictures for potential underlying malignancy. Patients generally proceed to a pancreatoduodenectomy if there is concern for pancreatic or peripancreatic neoplasm and the patient is an operable candidate. Some patients undergo pancreatoduodenectomy for what is eventually determined to be benign disease. We sought to analyze ERCP brushings to determine predictive factors for malignancy at our centre and whether brushing results influenced decision for pancreatoduodenectomy. Methods Retrospective review was conducted on adult patients who underwent ERCP with biliary duct brushings for cytology at the QEII Health Sciences Centre in Halifax, NS, from 2013–2014. Bile duct brushing cytology reports were identified by electronic search of hospital pathology archives (Cerner Millenium, Cerner, Kansas City, MO). Information on gender, age, symptoms, biliary stricture location and endoscopic impression, presence of pancreatic mass, cytologic impression of brushings, CA 19-9 level, CEA level, surgical intervention and clinical outcome was collected. Abnormal cytology was defined as samples reported as suggestive of malignancy or positive for malignant cells. Basic descriptive statistics and qualitative analysis were performed. Results A total of 185 ERCP patients had biliary brushings for cytology during the study time period. Patients who received biliary brushings were more likely to be between ages 60 to 79 (56%) with a mean age of 66. Presenting symptoms included elevated liver enzymes (82%), jaundice (75%) and pain (48%). Location of biliary stricture, age and gender were not associated with abnormal cytology results. Endoscopic impression of the biliary stricture was malignant in 53% of cases and associated with increased likelihood of abnormal cytology (39/92; p < 0.001). Pancreatic mass on imaging, seen in 38%, was associated with abnormal cytology (25/69, p = 0.001). Elevated CEA, but not CA 19-9, was associated with abnormal cytology (13/23; p = 0.008). Patients who received a pancreatoduodenectomy were not more likely to have abnormal cytology (5/18, p = 0.051). Patients eventually diagnosed with malignancy were more likely to have abnormal cytology on biliary brushing (49/120, p < 0.001). Conclusions Age, gender, location of stricture and elevated CA 19-9 were not associated with abnormal cytology suggestive of malignancy. The presence of a pancreatic mass, elevated CEA and eventual diagnosis of cancer were associated with abnormal cytology. Patients who received a pancreatoduodenectomy were not more likely to have abnormal cytology, which may reflect the scarcity of surgical candidates due to advanced disease at diagnosis. Funding Agencies None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».