Salman Majeed Chaudhry, Aamer Zaman Khan, Shabbir Chohan, Wasif Majeed Chaudhry, Samar Ghufran.
Bilirubin Level as a Predictor of Malignancy in patients with Obstructive Jaundice.
J Fatima Jinnah Med Uni Jan ;11(2):22-6.

Background: The aim of this study was to determine the diagnostic accuracy of high bilirubin level in the detection of malignant biliary disease in patients presenting with obstructive jaundice undergoing ERCP, taking histopathology as gold standard. Methods: This retrospective (cross-sectional) study was conducted at the Department of Surgery, Unit-I, Sir Ganga Ram Hospital, Lahore over 1 year period from January 2016 through December 2016. This study involved 70 patients of both genders who presented with obstructive jaundice (serum bilirubin level?21µmol/L) and underwent ERCP. Serum bilirubin level was acquired and patients were suspected of malignant disease if it was ?100µmol/L. Results of histopathology were taken as gold standard and diagnostic accuracy of serum bilirubin was judged accordingly. A written informed consent was obtained from every patient. Results: The mean age of the patients was 66.1±17.7 years. There were 36 (51.4%) male and 34 (48.6%) female patients in the study group. Mean serum bilirubin level was 170.6±89.3µmol/L. Using a cut-off value of serum bilirubin ?100µmol/L as marker of malignancy, 52 (74.3%) patients were labeled to have malignant disease while malignancy was confirmed in 27 (38.6%) patients on histopathology. When compared among patients with benign and malignant disease on histopathology, malignant disease was associated with significantly higher mean age (74.9±13.3 years vs. 60.6±18.0 years; p-value<0.001) and mean serum bilirubin level (238.0±85.2 µmol/L vs. 128.3±62.2 µmol/L; p-value<0.001). When crosstabulated the diagnosis on serum bilirubin and histopathology, there were 26 true positive, 26 false positive, 1 false negative and 17 true negative cases. It yielded 96.3% sensitivity, 39.5% specificity and 61.4% accuracy with positive and negative predictive values of 50.0% and 94.4% respectively for serum bilirubin level (?100µmol/L) taking histopathology as gold standard. Similar diagnostic performance was seen across age and gender groups. Conclusion: Serum bilirubin level (?100µmol/L) was found to be extremely sensitive but less specific marker of malignancy in patients of obstructive jaundice which make it a good screening tool for malignancy among such patients.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com