Utility of Bile Duct Brushings for the Early Detection of Cholangiocarcinoma in Patients With PSC.

April 28, 2006

Utility of Bile Duct Brushings for the Early Detection of Cholangiocarcinoma in Patients With

Primary Sclerosing Cholangitis.

Journal of Clinical Gastroenterology. 40(4):336-341,

April 2006.

Moff, L. MD *; , P. MD +; Maitra, Anirban MBBS +; Pandey, Akhilesh MD, PhD ++; Thuluvath, J. MD, FRCP *

Abstract:

Background: In patients with primary sclerosing cholangitis, there are no reliable markers or imaging

modalities to detect malignant changes or early cholangiocarcinoma

when curative interventions may still be possible.

Methods: Clinical features and

outcomes were evaluated for 47 patients who underwent 101 endoscopic

retrograde cholangiopancreatography (ERCP) procedures

with bile duct brushings and cytopathologic

examination for the detection of malignant changes between January 2001 and

2004. Bile duct cytology was characterized as unsatisfactory, benign, atypical,

or malignant.

Results: Fifteen patients had at

least one sample that was abnormal. Patients with abnormal findings were older

(P=0.03); otherwise the groups were similar. Three of six patients with marked atypia have undergone transplantation for these abnormal

findings, and of these, two had cholangiocarcinoma

and one had no cancer detected in the explant. Of the

nine patients with focal atypia, seven are doing

well, one underwent transplantation for marked atypia

seen on brushings at another hospital, and the other underwent transplantation

for decompensated cirrhosis. Two patients with benign findings developed cholangiocarcinoma, whereas 29 others have not.

Conclusion: Cytopathologic

examination of bile duct brushings taken at ERCP may be useful for the early

detection of malignant changes in patients with primary sclerosing

cholangitis. However, long-term prospective studies

are needed to confirm the utility of surveillance ERCP and brushings.

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