This article is more than 5 years old. Information may no longer be current.

Bile VEGF levels distinguish pancreatic cancer from other biliary stricture causes

SAN DIEGO — Levels of vascular endothelial growth factor in bile may aid in the diagnosis of pancreatic cancer, according to a study presented at the American College of Gastroenterology Annual Scientific Meeting.

Researchers measured the levels of vascular endothelial growth factor (VEGF) in bile directly aspirated from the common bile duct during endoscopic retrograde cholangiography (ERCP) by 53 consecutive patients. The cohort included 18 patients with primary sclerosing cholangitis (PSC); 15 with pancreatic cancer; 11 with benign biliary conditions, including sphincter of Oddi and choledocholihiasis; and nine patients with cholangiocarcinoma (CCA). A second, independent cohort of 10 patients with pancreatic cancer and eight with benign conditions was used to validate the diagnostic performance of VEGF measurement.

Patients with pancreatic cancer had significantly higher median VEGF levels than patients with PSC (0.7 ng/mL; P=.02), CCA (0.4 ng/mL; P<.001) or benign conditions (1.9 ng/mL compared with 0.3 ng/mL; P<.001). AUC analysis indicated a sensitivity of 93.3% and specificity of 88.9% for distinguishing pancreatic cancer from CCA for a VEGF, and 93.3% and 72.7%, respectively, for distinguishing cancer from benign biliary conditions, at a cut-off of 0.5 ng/mL. Results from the validation cohort confirmed the accuracy of VEGF, and staining via immunohistochemistry among patients with high VEGF levels also confirmed that these values were the result of pancreatic cancer cells secreting into the bile.

“Clinicians are at a dilemma when they see patients with indeterminate biliary stricture … patients who present only with narrowing of the bile duct, without any other findings such as mass,” researcher Udayakumar Navaneethan, MD, advanced therapeutic endoscopy fellow at Cleveland Clinic, told Healio.com. “Our biomarkers would be particularly useful in approaching patients with indeterminate biliary stricture and diagnosing accurately. Also, in patients with chronic pancreatitis, it would be very difficult to diagnose pancreatic cancer. Differentiating these two conditions using this biomarker will be clinically very attractive.” Navaneethan said the investigators plan to recruit additional patients and assess VEGF as a biomarker in a larger study.

Disclosure: The researchers report no relevant financial disclosures.

For more information:

Navaneethan U. #4: Vascular Endothelial Growth Factor Levels in Bile Distinguishing Pancreatic Cancer from Other Etiologies of Biliary Stricture. Presented at: the 2013 American College of Gastroenterology Annual Scientific Meeting; Oct. 11-16, San Diego.