{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T19:57:19Z","timestamp":1785182239897,"version":"3.55.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T00:00:00Z","timestamp":1616025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Atypical cellular features are commonly encountered in patients with indeterminate biliary strictures, which are nondiagnostic of malignancy yet cannot rule it out. This study aims to identify clinical features that could discriminate patients with indeterminate biliary strictures and atypical biliary cytology who may harbor underlying malignancy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All patients with an indeterminate biliary stricture and an atypical brush cytology obtained during endoscopic brushings were identified in a large tertiary-care center. Demographical information, clinical data and the final pathological diagnosis were collected. The study cohort was divided based on the final diagnosis into benign and malignant groups. Descriptive and multivariable analyses were performed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 151 patients were included in the analysis. Of these, 62.9% were males with mean age of 61.7 \u00b1 16.4 years. Overall, there was an almost equal distribution of patients in the benign and malignant groups. Older age (\u226565 years), jaundice, weight loss, intrahepatic biliary and pancreatic duct dilation, double-duct sign and presence of a mass were associated with malignancy in the univariate analysis. However, only older age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00 to 1.03), jaundice (OR 3.33, 95% CI 1.11 to 9.98) and presence of a mass (OR 12.10, 95% CI 4.94 to 29.67) were significantly associated with malignancy in the multivariate analysis. High CA19-9 was associated with malignancy only in patients with primary sclerosing cholangitis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In patients with indeterminate biliary stricture and atypical brush cytology, older age, jaundice and presence of a mass are significant predictors of malignancy. Patients with such characteristics need prompt evaluation to rule out underlying malignancy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jcag\/gwaa043","type":"journal-article","created":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T04:27:21Z","timestamp":1615868841000},"page":"222-228","source":"Crossref","is-referenced-by-count":9,"title":["Predictors of Malignancy in Patients With Indeterminate Biliary Strictures and Atypical Biliary Cytology: Results From Retrospective Cohort Study"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4174-9977","authenticated-orcid":false,"given":"Ali","family":"Alali","sequence":"first","affiliation":[{"name":"The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"},{"name":"Haya Al-Habeeb Gastroenterology and Hepatology Center, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Moris","sequence":"additional","affiliation":[{"name":"The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"},{"name":"Digestive Disease Department, Marqu\u00e9s de Valdecilla University Hospital, Cantabria University, Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myriam","family":"Martel","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Streutker","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, St. Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Cirocco","sequence":"additional","affiliation":[{"name":"The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Mosko","sequence":"additional","affiliation":[{"name":"The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Kortan","sequence":"additional","affiliation":[{"name":"The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Barkun","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary R","family":"May","sequence":"additional","affiliation":[{"name":"The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael\u2019s Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,3,18]]},"reference":[{"issue":"6","key":"2021100414562909100_CIT0001","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1097\/MCG.0b013e3182745d9f","article-title":"Patients with obstructive jaundice and biliary stricture \u00b1 mass lesion on imaging: Prevalence of malignancy and potential role of EUS-FNA","volume":"47","author":"Tummala","year":"2013","journal-title":"J Clin Gastroenterol"},{"issue":"1","key":"2021100414562909100_CIT0002","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1093\/qjmed\/hci004","article-title":"Contrasting liver function test patterns in obstructive jaundice due to biliary strictures [corrected] and stones","volume":"98","author":"Hayat","year":"2005","journal-title":"QJM"},{"issue":"1","key":"2021100414562909100_CIT0003","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/S1479-666X(03)80006-9","article-title":"Incidence of benign pathology in patients undergoing hepatic resection for suspected malignancy","volume":"1","author":"Clayton","year":"2003","journal-title":"Surgeon"},{"issue":"1","key":"2021100414562909100_CIT0004","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1046\/j.1365-2168.2001.01607.x","article-title":"Incidence of benign lesions in patients resected for suspicious hilar obstruction","volume":"88","author":"Gerhards","year":"2001","journal-title":"Br J Surg"},{"issue":"6","key":"2021100414562909100_CIT0005","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.jamcollsurg.2005.07.011","article-title":"Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma","volume":"201","author":"Corvera","year":"2005","journal-title":"J Am Coll Surg"},{"issue":"12","key":"2021100414562909100_CIT0006","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1177\/000313481207801232","article-title":"Clinicopathological features of benign biliary strictures masquerading as biliary malignancy","volume":"78","author":"Wakai","year":"2012","journal-title":"Am Surg"},{"issue":"3","key":"2021100414562909100_CIT0007","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.giec.2012.05.006","article-title":"Sampling at ERCP for cyto- and histopathologicical examination","volume":"22","author":"Dumonceau","year":"2012","journal-title":"Gastrointest Endosc Clin N Am"},{"issue":"1","key":"2021100414562909100_CIT0008","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.gie.2014.09.017","article-title":"Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: A systematic review and meta-analysis","volume":"81","author":"Navaneethan","year":"2015","journal-title":"Gastrointest Endosc"},{"key":"2021100414562909100_CIT0009","first-page":"435","article-title":"Reclassification of \u2018\u2018atypical\u2019\u2019 diagnoses in endoscopic retrograde cholangiopancreaticography-guided biliary brushings","volume":"47","author":"Okonkwo","year":"2003","journal-title":"ActaCytol"},{"issue":"4","key":"2021100414562909100_CIT0010","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1002\/cncr.21842","article-title":"Pancreatic and bile duct brushing cytology in 1000 cases: Review of findings and comparison of preparation methods","volume":"108","author":"Volmar","year":"2006","journal-title":"Cancer"},{"issue":"6","key":"2021100414562909100_CIT0011","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1136\/jcp.54.6.449","article-title":"Brush cytology in the assessment of pancreatico-biliary strictures: A review of 406 cases","volume":"54","author":"Stewart","year":"2001","journal-title":"J Clin Pathol"},{"issue":"5","key":"2021100414562909100_CIT0012","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1002\/dc.10098","article-title":"Brush cytology of the biliary tract: Retrospective study of 278 cases with histopathologic correlation","volume":"26","author":"Govil","year":"2002","journal-title":"Diagn Cytopathol"},{"issue":"3","key":"2021100414562909100_CIT0013","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1309\/J030JYPWKQTHCLNJ","article-title":"Biliary brush cytology and the detection of cholangiocarcinoma in primary sclerosing cholangitis: Evaluation of specific cytomorphologic features and CA19-9 levels","volume":"124","author":"Furmanczyk","year":"2005","journal-title":"Am J Clin Pathol"},{"key":"2021100414562909100_CIT0014","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/1742-6413.133343","article-title":"Standardized terminology and nomenclature for pancreatobiliary cytology: The Papanicolaou Society of Cytopathology Guidelines","volume":"11","author":"Pitman","year":"2014","journal-title":"Cytojournal"},{"issue":"2","key":"2021100414562909100_CIT0015","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s12029-011-9284-y","article-title":"Risk factors for gallbladder cancer and cholangiocarcinoma: Similarities, differences and updates","volume":"43","author":"Rustagi","year":"2012","journal-title":"J Gastrointest Cancer"},{"issue":"1","key":"2021100414562909100_CIT0016","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/S1055-3207(18)30285-0","article-title":"Epidemiology of and risk factors for pancreatic cancer","volume":"7","author":"Gold","year":"1998","journal-title":"Surg Oncol Clin N Am"},{"key":"2021100414562909100_CIT0017","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1002\/dc.22924","article-title":"Identification of factors predictive of malignancy in patients with atypical biliary brushing results obtained via ERCP","volume":"41","author":"Witt","year":"2013","journal-title":"Diagn Cytopathol"},{"issue":"10","key":"2021100414562909100_CIT0018","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1111\/j.1477-2574.2012.00508.x","article-title":"Multimodality imaging of pancreatic ductal adenocarcinoma: A review of the literature","volume":"14","author":"Shrikhande","year":"2012","journal-title":"HPB"},{"issue":"2","key":"2021100414562909100_CIT0019","first-page":"132","article-title":"Which is the best imaging method in pancreatic adenocarcinoma diagnosis and staging - CT, MRI or EUS?","volume":"43","author":"Costache","year":"2017","journal-title":"Curr Health Sci J"},{"issue":"5","key":"2021100414562909100_CIT0020","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.gie.2013.09.015","article-title":"Diagnostic yield of bile duct brushings for cholangiocarcinoma in primary sclerosing cholangitis: A systematic review and meta-analysis","volume":"79","author":"Trikudanathan","year":"2014","journal-title":"Gastrointest Endosc"},{"key":"2021100414562909100_CIT0021","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1093\/annonc\/10.suppl_4.S308","article-title":"Risk factors for biliary tract carcinogenesis","volume":"10","author":"Chapman","year":"1999","journal-title":"Ann Oncol"},{"issue":"9","key":"2021100414562909100_CIT0022","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1007\/s10620-005-2927-8","article-title":"The value of serum CA 19-9 in predicting cholangiocarcinomas in patients with primary sclerosing cholangitis","volume":"50","author":"Levy","year":"2005","journal-title":"Dig Dis Sci"},{"issue":"5","key":"2021100414562909100_CIT0023","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.cgh.2011.02.007","article-title":"Many patients with primary sclerosing cholangitis and increased serum levels of carbohydrate antigen 19-9 do not have cholangiocarcinoma","volume":"9","author":"Sinakos","year":"2011","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"2021100414562909100_CIT0024","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.gie.2011.08.022","article-title":"Polysomy and p16 deletion by fluorescence in situ hybridization in the diagnosis of indeterminate biliary strictures","volume":"75","author":"Gonda","year":"2012","journal-title":"Gastrointest Endosc"},{"issue":"4","key":"2021100414562909100_CIT0025","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/j.gie.2015.04.030","article-title":"Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures: A systematic review","volume":"82","author":"Navaneethan","year":"2015","journal-title":"Gastrointest Endosc"}],"container-title":["Journal of the Canadian Association of Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcag\/article-pdf\/4\/5\/222\/40505103\/gwaa043.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jcag\/article-pdf\/4\/5\/222\/40505103\/gwaa043.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T01:12:50Z","timestamp":1633396370000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcag\/article\/4\/5\/222\/6177942"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,18]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,3,18]]},"published-print":{"date-parts":[[2021,10,4]]}},"URL":"https:\/\/doi.org\/10.1093\/jcag\/gwaa043","relation":{},"ISSN":["2515-2084","2515-2092"],"issn-type":[{"value":"2515-2084","type":"print"},{"value":"2515-2092","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,10,1]]},"published":{"date-parts":[[2021,3,18]]}}}