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Endoscopy 2016; 48(05): 432-439
DOI: 10.1055/s-0041-110792
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Screening primary sclerosing cholangitis and biliary dysplasia with endoscopic retrograde cholangiography and brush cytology: risk factors for biliary neoplasia

Sonja Boyd   *
1   University of Helsinki and Helsinki University Hospital, HUSLAB Department of Pathology, Helsinki, Finland
,
Andrea Tenca   *
2   University of Helsinki and Clinic of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
3   Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
,
Kalle Jokelainen
2   University of Helsinki and Clinic of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
,
Harri Mustonen
4   Department of Surgery, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki, Finland
,
Leena Krogerus
5   University of Helsinki and Helsinki University Hospital – Jorvi, Espoo, Finland
,
Johanna Arola
1   University of Helsinki and Helsinki University Hospital, HUSLAB Department of Pathology, Helsinki, Finland
,
Martti A. Färkkilä
2   University of Helsinki and Clinic of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
› Author Affiliations
Further Information

Publication History

submitted 25 May 2015

accepted after revision 10 November 2015

Publication Date:
25 January 2016 (online)

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Background and study aims: Primary sclerosing cholangitis (PSC) is associated with increased risk of biliary dysplasia and cholangiocarcinoma (CCA). The aim of this study was to evaluate the role of early endoscopic retrograde cholangiography (ERC) with systematic brush cytology to identify risk factors associated with biliary neoplasia.

Patients and methods: Patients who were referred for their first ERC for suspicion of PSC between January 2006 and October 2011 were included in the study. Brush cytology specimens were scored as benign, suspicious, or malignant. End points were CCA, biliary dysplasia, benign histology, or benign disease course for ≥ 2 years.

Results: PSC was diagnosed in 261 patients (125 men, 136 women), most of whom were asymptomatic (n = 211). Cholangiographic changes were mild in 57.1 %. Men presented with advanced disease more often than women. Brush cytology was benign in 243, suspicious in 16, and malignant in 2 patients. Follow-up completed in 249 patients indicated a benign disease course in 232 patients. Seven patients were diagnosed with CCA and eight had biliary dysplasia in the explanted liver. Thus, 15 patients had biliary neoplasia, and suspicious or malignant brush cytology had been detected in 8 of them at initial brushing. Advanced extrahepatic cholangiographic changes with elevated aminotransferases at diagnosis seemed to be associated with increased risk of biliary neoplasia.

Conclusions: Even in mostly asymptomatic patients with PSC, 42.9 % had advanced disease and 6.9 % presented with suspicious or malignant brush cytology at first ERC. Advanced extrahepatic ERC changes with elevated aminotransferases at diagnosis might be risk factors for biliary neoplasia.

* These authors contributed equally to this work.


 

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