Serum Bilirubin Levels Can Predict Pancreatic and Biliary Malignancies in Patients with Obstructive Jaundice and Non-conclusive Cytology

Abstract

Background: Elevated serum bilirubin has been shown to be a reliable predictor of pancreatic and biliary malignancy but the relationship between serum bilirubin and inadequate (C1), benign (C2) and indeterminate (C3) cellular samples has not been explored. The aim of this study is to determine the relationship between serum bilirubin and pancreatic, biliary or ampullary malignancy in the context of non-confirmatory cytology. Methods: This is a retrospective analysis of patients with obstructive jaundice undergoing investigation for possible pancreatic, peri-ampullary or biliary malignancy between 2009 and 2013. Results: 135 patients were included; 84 had a malignant diagnosis and 51 benign. All patients with C4 or C5 cytology (n=49) had confirmed malignancy. 35 out of 86 C1-C3 samples were falsely negative. ROC curve analysis demonstrated a strong association (AUC 0.912) between elevated serum bilirubin and malignancy; serum bilirubin ≥ 100 µmol/L had a sensitivity of 86% and a specificity of 88%. In the C1-C3 subgroup, this association was maintained (AUC 0.905). Serum bilirubin ≥ 100 µmol/L had a sensitivity of 80% and specificity of 88%. Using this cutoff highlighted 28 out of 35 of the malignancies missed by cytology (p = 0.003). Conclusion: Our study demonstrates that a serum bilirubin ≥ 100 µmol/L is associated with malignancy and this relationship is maintained in C1-C3 cytology. When faced with non-confirmatory cytology in the absence of a benign aetiology and an elevated serum bilirubin ≥ 100 µmol/L, we advocate more aggressive investigation to avoid missing an occult malignancy.

Hesperidin ameliorates hepatic dysfunction and dyslipidemia in male Wistar rats exposed to cadmium chloride

“…Bilirubin is an important molecule with multiple biological functions. Total bilirubin is the sum of the un-conjugated and conjugated fractions and its serum elevation has been implicated in various liver diseases in addition to pancreatic and biliary malignancy, hemolytic disorders, several inherited enzyme deficiencies, and conditions causing hepatic obstructions [ 52 , 53 ]. Therefore serum AST, ALT and ALP activities in addition to direct bilirubin and albumin levels are valuable aid in routine clinical diagnosis of liver diseases [ 49 , 50 , 54 , 55 ].…”

Perbedaan Kadar Bilirubin Serum antara Kelompok Patologi Neoplasma dan Non-neoplasma pada Ikterus Obstruktif

“…Neoplasma menyebabkan kompresi ekstra-lumen yang progresif dan irreversibel sehingga kadar bilirubin secara signifikan lebih tinggi dibandingkan kelompok non-neoplasma. 31 Selain itu, sebagian besar neoplasma menyebabkan obstruksi total pada saluran empedu, sedangkan non-neoplasma cenderung menyebabkan obstruksi yang intermiten atau parsial pada saluran empedu. 32 Batu empedu terutama batu kolesterol bersifat lebih ringan dari cairan empedu, sehingga ketika terjadi distensi saluran empedu, batu empedu akan mengapung ke proksimal dan melepaskan obstruksi akibat batu tersebut.…”

Advantages of Total Bilirubin for Predicting Malignant Obstructive Jaundice, A Combination of the Pandemic Era and Limited Resources Settings

“…For late-detected diseases disorders, pre-operative drainage is more helpful in improving operative treatment outcomes and prolonging survival [10], [11], [12]. The previous research publications on total bilirubin from different times and sample backgrounds, show the ability and variation of threshold value as a predictors of malignant obstructive jaundice [13], [14], [15]. Within the existing limitations, against time, to prevent further consequences of obstructive malignant jaundice, an initial diagnostic predictor is needed for recommending further diagnostic modalities, referral, and curative or palliative decisions [13].…”