Biliary Strictures

Pancreaticobiliary Molecular Testing

The PancraGEN® molecular panel, powered by PathfinderTG®, provides risk stratification of a patient’s pancreaticobiliary sample by integrating clinical features and the following test components:

  • Oncogene point mutations (KRAS and GNAS)

  • Tumor suppressor gene mutations (Loss of Heterozygosity through fragment analysis)

View video excerpts of Dr. Ligresti’s perspectives on the controversies and current strategies, including the use of molecular testing, in the diagnosis and management of indeterminate biliary strictures.

Clinical evaluation of biliary strictures can be challenging7,8

Mutation profiling can help significantly increase the detection of biliary malignancies

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Diagnosis and Management of Biliary Strictures:

A review of current strategies and controversies in the diagnosis and management of indeterminate biliary strictures

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Rosario Ligresti, MD, FASGE

Chief, Division of Gastroenterology
Director, The Pancreas Center
Hackensack University Medical Center

Core Associate Professor of Medicine
Hackensack Meridian School of Medicine

Medical Director, National Pancreas Foundation

Limitations and Disclaimers1

Although PancraGEN is highly specific for malignancy, some malignant cysts may not be detected. There may also be individuals who are falsely identified as having a malignant cyst. Diagnosis and appropriate patient management are the responsibility of the referring physician or healthcare provider.

References

  1. Al-Haddad MA, Kowalski T, Siddiqui A, et al. Integrated molecular pathology accurately determines the malignant potential of pancreatic cysts. Endoscopy. 2015;47(2):136-146.
  2. V. Chernyak et al, Incidental pancreatic cystic lesions Radiology 2015 274 161-9
  3. BU Wu, et al, Prediction of malignancy in cystic neoplasms of the pancreas: a population based cohort study, Am J Gastro 2014 109 121-9
  4. Loren D, Kowalski T, Siddiqui A, et al. Influence of integrated molecular pathology test results on real-world management decisions for patients with pancreatic cysts: analysis of data from a national registry cohort. Diagnostic Pathology. 2016;11:5. doi:10.1186/s13000-016-0462-x.
  5. Gaujoux S., , Brennan, M., et al. Cystic Lesions of the Pancreas: Changes in the Presentation and Management of 1,424 Patients at a Single Institution over a 15-year Time Period. J Am Coll Surg. 2011 April; 212(4): doi:10.1016/j.jamcollsurg.2011.01.016.
  6. Kaimalkliotis, P., Riff, B., et al. Sendai and Fukuoka Consensus Guidelines Identify Advanced Neoplasia in Patients With Suspected Mucinous Cystic Neoplasms of the Pancreas. Clinical Gastroenterology and Hepatology 2015;13:1808–1815: doi:10.1016/j.cgh.2015.03.017
  7. Kushnir VM, Mullady DK, Das K, et al. J Clin Gastroenterol. 2019;53(9):686-692. DOI: 10.1097/MCG.0000000000001118.
  8. Gonda TA, Viterbo D, Gausman V, et al. Clin Gastroenterol Hepatol. 2017;15:913-919.
  9. Data on File.