BACKGROUND: Determining the benign or malignant nature of biliary strictures can be challenging. Vascular endothelial growth factor (VEGF) plays an important role in tumor angiogenesis. OBJECTIVE: The purpose of this study was to investigate whether VEGF levels in bile aspirated during endoscopic retrograde cholangiography (ERCP) can distinguish pancreatic cancer from other causes of biliary stricture. METHODS: Bile was directly aspirated in 53 consecutive patients from March 2012 to October 2012 during ERCP from the common bile duct including 15 with pancreatic cancer, 18 with primary sclerosing cholangitis (PSC), nine with cholangiocarcinoma (CCA), and 11 with benign biliary conditions (sphincter of Oddi and choledocholihiasis). Levels of VEGF in bile were measured. The diagnostic performance was then validated in a second, independent validation cohort of 18 patients (pancreatic cancer n = 10, benign n = 8). RESULTS: A total of 53 consecutive patients were recruited. The median bile VEGF levels were significantly elevated in patients with pancreatic cancer (1.9 ng/ml (interquartile range [IQR] 0.7, 2.2) compared to those with benign biliary conditions (0.3 ng/ml [IQR 0.2, 0.6]; p < 0.001), PSC (0.7 ng/ml [IQR 0.5, 0.9]; p = 0.02) or CCA (0.4 ng/ml [IQR 0.1, 0.5]; p < 0.001). A VEGF cut-off value of 0.5 ng/ml distinguished pancreatic cancer from CCA with a sensitivity and specificity of 93.3 and 88.9 %, respectively, and area under curve (AUC) of 0.93, and from benign conditions with a sensitivity and specificity of 93.3 and 72.7 %, respectively, with AUC of 0.89. The diagnostic accuracy of biliary VEGF was confirmed in the second independent validation cohort. CONCLUSIONS: This study suggests that measurement of biliary VEGF-1 levels distinguishes patients with pancreatic cancer from other etiologies of biliary stricture. This may be particularly relevant in approaching patients with indeterminate biliary stricture.
BACKGROUND: Determining the benign or malignant nature of biliary strictures can be challenging. Vascular endothelial growth factor (VEGF) plays an important role in tumor angiogenesis. OBJECTIVE: The purpose of this study was to investigate whether VEGF levels in bile aspirated during endoscopic retrograde cholangiography (ERCP) can distinguish pancreatic cancer from other causes of biliary stricture. METHODS: Bile was directly aspirated in 53 consecutive patients from March 2012 to October 2012 during ERCP from the common bile duct including 15 with pancreatic cancer, 18 with primary sclerosing cholangitis (PSC), nine with cholangiocarcinoma (CCA), and 11 with benign biliary conditions (sphincter of Oddi and choledocholihiasis). Levels of VEGF in bile were measured. The diagnostic performance was then validated in a second, independent validation cohort of 18 patients (pancreatic cancer n = 10, benign n = 8). RESULTS: A total of 53 consecutive patients were recruited. The median bile VEGF levels were significantly elevated in patients with pancreatic cancer (1.9 ng/ml (interquartile range [IQR] 0.7, 2.2) compared to those with benign biliary conditions (0.3 ng/ml [IQR 0.2, 0.6]; p < 0.001), PSC (0.7 ng/ml [IQR 0.5, 0.9]; p = 0.02) or CCA (0.4 ng/ml [IQR 0.1, 0.5]; p < 0.001). A VEGF cut-off value of 0.5 ng/ml distinguished pancreatic cancer from CCA with a sensitivity and specificity of 93.3 and 88.9 %, respectively, and area under curve (AUC) of 0.93, and from benign conditions with a sensitivity and specificity of 93.3 and 72.7 %, respectively, with AUC of 0.89. The diagnostic accuracy of biliary VEGF was confirmed in the second independent validation cohort. CONCLUSIONS: This study suggests that measurement of biliary VEGF-1 levels distinguishes patients with pancreatic cancer from other etiologies of biliary stricture. This may be particularly relevant in approaching patients with indeterminate biliary stricture.
Authors: Domenico Alvaro; Barbara Barbaro; Antonio Franchitto; Paolo Onori; Shannon S Glaser; Gianfranco Alpini; Heather Francis; Luca Marucci; Paola Sterpetti; Stefano Ginanni-Corradini; Andrea Onetti Muda; David E Dostal; Adriano De Santis; Adolfo F Attili; Antonio Benedetti; Eugenio Gaudio Journal: Am J Pathol Date: 2006-09 Impact factor: 4.307
Authors: Marco Niedergethmann; Ralf Hildenbrand; Birgit Wostbrock; Mark Hartel; Jörg W Sturm; Axel Richter; Stefan Post Journal: Pancreas Date: 2002-08 Impact factor: 3.327
Authors: Todd H Baron; Gavin C Harewood; Ashwin Rumalla; Nicole L Pochron; Linda M Stadheim; Gregory J Gores; Terry M Therneau; Piet C De Groen; Thomas J Sebo; Diva R Salomao; Benjamin R Kipp Journal: Clin Gastroenterol Hepatol Date: 2004-03 Impact factor: 11.382
Authors: Domenico Alvaro; Gianpiero Macarri; Maria Grazia Mancino; Marco Marzioni; MariaConsiglia Bragazzi; Paolo Onori; Stefano Ginanni Corradini; Pietro Invernizzi; Antonio Franchitto; Adolfo F Attili; Eugenio Gaudio; Antonio Benedetti Journal: Ann Intern Med Date: 2007-10-02 Impact factor: 25.391
Authors: Udayakumar Navaneethan; Mansour A Parsi; Vennisvasanth Lourdusamy; Amit Bhatt; Norma G Gutierrez; David Grove; Madhusudhan R Sanaka; Jeffrey P Hammel; Tyler Stevens; John J Vargo; Raed A Dweik Journal: Gastrointest Endosc Date: 2014-12-12 Impact factor: 9.427