Aguilar Olivos Nancy Edith, Oria-Hernández Jesús, Briones Nicole Somerville, Téllez Ávila Félix Ignacio
Gastrointestinal Endoscopy Unit, Médica Sur Clinic and Foundation.
Biochemistry and Genetics Laboratory, National Institute of Pediatrics, Ministry of Health.
Surg Laparosc Endosc Percutan Tech. 2023 Apr 1;33(2):147-151. doi: 10.1097/SLE.0000000000001158.
Up to 70% of the cases of biliary strictures are cholangiocarcinoma. Cholangiocarcinoma has a late diagnosis and poor outcomes; therefore, effective biomarkers are needed for malignant lesions detection at earlier stages.
The aim was to assess the diagnostic utility of bile pyruvate kinase M2 (PKM2) as a biomarker for the detection of malignant biliary strictures in patients with an indeterminate biliary stricture.
This is a prospective study to evaluate the diagnostic value of bile PKM2 for the diagnosis of malignant biliary strictures. Bile samples were collected during Endoscopic Retrograde Cholangio Pancreatography to quantify PKM2 levels and were used to compare their diagnostic value with biliary brush cytology, endoscopic ultrasound-guided fine needle biopsy, or clinical follow-up.
Forty-six patients were recruited for the study; 19 patients with malignant strictures and 27 with benign biliary strictures. The bile PKM2 levels were elevated in patients with malignant biliary strictures [median 0.045 ng/mL (IQR 0.014 to 0.092)] compared with those with benign strictures [median 0.019 ng/mL (IQR 0.00 to 0.047)]. Bile PKM2 had a receiver-operating characteristic curve of 0.66 (0.49 to 0.83) with a cutoff value of bile PKM2 of 0.0017 ng/mL. The sensitivity and specificity of bile PKM2 for the diagnosis of cholangiocarcinoma were 89% and 26%; the positive and negative predictive values were 46% and 78%, respectively.
In patients with indeterminate biliary strictures, bile PKM2 may be a potential biomarker for the diagnosis of malignancy.
高达70%的胆管狭窄病例为胆管癌。胆管癌诊断较晚且预后较差；因此，需要有效的生物标志物用于在更早阶段检测恶性病变。
目的是评估胆汁丙酮酸激酶M2（PKM2）作为检测胆管狭窄情况不明患者恶性胆管狭窄生物标志物的诊断效用。
这是一项前瞻性研究，旨在评估胆汁PKM2对恶性胆管狭窄的诊断价值。在内镜逆行胰胆管造影期间收集胆汁样本以量化PKM2水平，并将其诊断价值与胆管刷检细胞学、内镜超声引导下细针穿刺活检或临床随访进行比较。
46名患者被纳入研究；19名患有恶性狭窄，27名患有良性胆管狭窄。与良性狭窄患者[中位数0.019 ng/mL（四分位间距0.00至0.047）]相比，恶性胆管狭窄患者的胆汁PKM2水平升高[中位数0.045 ng/mL（四分位间距0.014至0.092）]。胆汁PKM2的受试者工作特征曲线为0.66（0.49至0.83），胆汁PKM2的临界值为0.0017 ng/mL。胆汁PKM2诊断胆管癌的敏感性和特异性分别为89%和26%；阳性和阴性预测值分别为46%和78%。
在胆管狭窄情况不明的患者中，胆汁PKM2可能是诊断恶性肿瘤的潜在生物标志物。
