A328 FACTORS PREDICTIVE OF MALIGNANCY IN PATIENTS WITH BILIARY BRUSHINGS OBTAINED BY ERCP

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 ...