Sensitivity of alternative testing for pancreaticobiliary cancer: a 10-y review of the literature

Atuhani S Burnett; Joanelle Bailey; Joseph B Oliver; Sushil Ahlawat; Ravi J Chokshi

doi:10.1016/j.jss.2014.04.014

Sensitivity of alternative testing for pancreaticobiliary cancer: a 10-y review of the literature

J Surg Res. 2014 Aug;190(2):535-47. doi: 10.1016/j.jss.2014.04.014. Epub 2014 Apr 13.

Authors

Atuhani S Burnett¹, Joanelle Bailey², Joseph B Oliver², Sushil Ahlawat², Ravi J Chokshi²

Affiliations

¹ Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey. Electronic address: burnetat@njms.rutgers.edu.
² Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.

PMID: 24969546
DOI: 10.1016/j.jss.2014.04.014

Abstract

Background: Biliary strictures present a diagnostic challenge to differentiate benign disease from hepatopancreaticobiliary (HPB) malignancies. Endoscopic retrograde cholangiopancreatography cytology is commonly performed in these patients; however, its sensitivity for diagnosis of HPB malignancy is poor (41.6%). Many adjunctive tests have been investigated to improve the sensitivity of HPB biopsies. To determine the best tests available, however, we reviewed the literature and performed a comparative analysis of all recently investigated tests and their sensitivities.

Methods: A PubMed search identified articles published between 2003 and 2014, describing alternate methods for diagnosing HPB malignancies, reported sensitivity, final pathology, and had data available online. Meta-analysis was conducted for tests with multiple articles. Tests with the highest sensitivity and specificities were reported.

Results: A total of 77 studies were identified. Meta-analysis was performed on the sensitivity of EUS-FNA (74.2%), fluorescence in situ hybridization (54.2%), immunostain of insulin-like growth factor 2 mRNA-binding Protein 3 (IMP3; 80.4%), IMP3 + cytology (86.4%), K homology domain containing protein overexpressed in cancer (KOC; 85.9%), S100P (77.8%), serum CA19-9 (69.3%), and K-ras mutations (47.0%) to detect malignancy. Ultimately, 12 tests were identified with superior sensitivity (85.3%-100%) and specificities (81.6%-100%) including stricture scrapping, brush sectioning, IMP3 stain + cytology, IMP3+S100A4, bile carcinoembryonic cell adhesion molecule 6 protein (±CA19-9), bile micro RNA (miRNA)-135b, serum miRNA-RNU2-1f, serum miRNA-21 (+CA19-9), peripheral blood mononuclear cells miRNA-27a-3p (+CA19-9), serum miRNA-16 + miRNA-196a (+CA19-9), peripheral blood mononuclear cells mRNAs h-TERT + CK20 + CEA + C-MET.

Conclusions: We recommend immunostaining with a panel of IMP3+KOC + S100A4 + cytology to achieve maximum sensitivity and specificity from HPB biopsies. One biliary protein (carcinoembryonic cell adhesion molecule 6) and several RNAs (bile and blood) offer exceptional sensitivity and specificity and should be tested prospectively in larger populations. Overall, this review identifies several tests to improve the sensitivity of diagnostic algorithms to identify HPB malignancies.

Keywords: Biliary cancer; ERCP; Pancreatic cancer; Sensitivity.

Publication types

Comparative Study
Meta-Analysis
Review

MeSH terms

Biliary Tract Neoplasms / diagnosis*
Biliary Tract Neoplasms / pathology
Complementary Therapies / methods*
Complementary Therapies / trends*
Humans
Pancreatic Neoplasms / diagnosis*
Pancreatic Neoplasms / pathology
Sensitivity and Specificity