A328 FACTORS PREDICTIVE OF MALIGNANCY IN PATIENTS WITH BILIARY BRUSHINGS OBTAINED BY ERCP
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".