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Lipidomic bile profile distinguished benign vs. malignant biliary strictures
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Measurement of specific oxidized phospholipids in bile were sufficiently sensitive and specific to distinguish cholangiocarcinoma from other biliary strictures, according to new research results.
Investigators obtained bile from 46 patients undergoing endoscopic retrograde cholangiopancreatography for diagnosis and management of biliary strictures. Among patients in the prospective single-blinded study, 17 had pancreatic cancer, six had primary sclerosing cholangitis (PSC), eight had cholangiocarcinoma (CCA) and 15 were diagnosed with benign biliary conditions.
To minimize artificial oxidation, bile samples were stored under optimal conditions and levels of 10 different oxidized phospholipids (oxPL) were obtained through liquid chromatography electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) assay. Compared with other biliary strictures, levels of two phosphatidylcholines (PCs; ON-PC and S-PC) were elevated in CCA.
ON-PC was the most useful of the 10 measured, with a cutoff value of 6,020.1 nm distinguishing CCA from other biliary strictures (sensitivity, 85.7%; specificity, 80.3%; AUC=0.86).
At a cutoff value of 6,032.2 nm, a combination of ON-PC and S-PC distinguished CCA from other biliary strictures (sensitivity, 100%; specificity, 83.3%; AUC=0.91).
“Measurements of specific [oxPL] in bile have high sensitivity and specificity to distinguish cholangiocarcinoma from other etiologies of structures,” the researchers wrote. “Although the potential cost for performing our analysis with mass spectrometry is higher than fluorescence in situ hybridization, development of enzyme-linked immunosorbent assay-based assay for specific markers would make these tests cheaper.”
Disclosure: Researcher John J. Vargo, MD, MPH, is a consultant for Olympus America, Boston Scientific, Cook Medical, and Ethicon EndoSurgery. Researcher Tyler Stevens, MD, MS, is a consultant and speaker for Boston Scientific.
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