Primary sclerosing cholangitis is associated with a high risk of cholangiocarcinoma development.
Efforts should be made to detect early neoplastic changes that can be radically treated by liver transplantation.
Dr Kirsten Muri Boberg and colleagues from Norway conducted a prospective case series in 61 primary sclerosing cholangitis patients.
The investigative team collected brush cytology specimens from bile duct strictures in these patients.
The cytological classifications were compared with histopathological findings in bile ducts from explanted livers or clinical outcome.
|The sensitivity of brush cytology in malignancy diagnosis was 100%|
|Journal of Hepatology|
The investigators found that 15% of patients had cytological low-grade, and 21% had high-grade dysplasia/adenocarcinoma.
The team noted that 36% had cholangiocarcinoma and 32% presented with high-grade dysplasia in bile ducts from explanted livers.
The team observed that sensitivity, and specificity of brush cytology in diagnosis of biliary malignancy were 100%, and 84%, respectively, for combined low- and high-grade dysplasia.
The positive- and negative predictive values, and accuracy of brush cytology in diagnosis for both low- and high-grade dysplasia were 68%, 100%, and 88%.
For high-grade dysplasia/adenocarcinoma only, brush cytology diagnositic sensitivity and specificity were 73%, and 95%.
The positive- and negative predictive values, and accuracy of brush cytology in diagnosis for high-grade dysplasia only were 85%, 91%, and 90%.
The investigators found that all patients with high-grade biliary epithelial dysplasia in explanted bile ducts were tumour free at follow-up.
Dr Boberg's team concluded, “Brush cytology from bile duct strictures in primary sclerosing cholangitis patients can detect cholangiocarcinoma in situ.”
“Patients with cytological low-grade and high-grade dysplasia/adenocarcinoma are currently referred for liver transplantation in our hospital.”