Background and Aims
Endobiliary brushings are routinely used in the diagnosis, treatment, and prognostication
of biliary strictures. However, standard Papanicolaou (Pap) staining has a low sensitivity
in this setting, and the accuracy of brush cytology has not been established for indeterminate
strictures. We therefore evaluated the diagnostic merit of methionyl-transfer RNA
synthetase 1 (MARS1) immunofluorescence (IF) staining in such cytologic specimens.
Methods
During ERCP, endobiliary brushings were obtained from patients with extrahepatic biliary
strictures prospectively enrolled at 6 tertiary hospitals. Using liquid-based cytologic
preparations of these samples, we performed Pap and MARS1 IF staining.
Results
In total, 240 patients were eligible; of these, we compared the Pap and MARS1 IF staining
results of 218 (malignant, 157; benign, 61). By conventional Pap staining, the diagnoses
were distributed as follows: malignant, 55; suspicious of malignancy, 60; atypical,
45; negative for malignancy, 58. MARS1 IF staining was strongly positive in malignant
biliary stricture but not so in specimens negative for malignancy. The diagnostic
parameters (sensitivity, specificity, positive predictive value, negative predictive
value, and accuracy) of the MARS1 IF (93.6%, 96.7%, 98.7%, 85.5%, and 94.5%, respectively)
and conventional Pap (73.2%, 100%, 100%, 59.2%, and 80.7%, respectively) staining
methods differed significantly (P < .0001).
Conclusions
The high sensitivity and accuracy of MARS1 IF staining enabled the detection of malignancy
in patients with biliary strictures. Further prospective studies are needed to validate
our findings. (Clinical trial registration number: NCT03708445.)
Graphical abstract
Graphical Abstract
Abbreviations:
CCM (conventional cytologic staining method), IF (immunofluorescence), MARS1 (methionyl-transfer RNA synthetase 1), NPV (negative predictive value), Pap (Papanicolaou), PPV (positive predictive value), tRNA (transfer RNA)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 05, 2021
Accepted:
April 27,
2021
Received:
December 16,
2020
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: S. I. Jang, J. H. Nahm, S. Kim, D. K. Lee: Financial interests in Oncotag Diagnostics. All other authors disclosed no financial relationships. Research support for this study was provided by grants NRF-2014M3A6A4074817 (D. K. Lee), NRF-M3A6A4-2010-0029785 (S. Kim), and NRF2015M3A6A4065724 (N.H. Kwon) from the Global Frontier National Research Foundation, Ministry of Science and ICT (MSIT) of Korea; grants NRF-2017M3A9F7079378 (N. H. Kwon) and NRF-2018M3A9F7062524 (S. I. Jang) from the National Research Foundation, MSIT of Korea.
If you would like to chat with an author of this article, you may contact Dr Lee at [email protected]
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© 2021 by the American Society for Gastrointestinal Endoscopy
