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DOI: 10.1055/s-2002-35298
Diagnosis of Biliary Strictures in Conjunction with Endoscopic Retrograde Cholangiopancreaticography, with Special Reference to Patients with Primary Sclerosing Cholangitis
Publication History
Submitted: 23 December 2001
Accepted after Revision: 29 May 2002
Publication Date:
13 November 2002 (online)
Background and Study Aims: Strictures of the bile ducts due to malignant changes are difficult to distinguish
from benign changes, particularly in patients with primary sclerosing cholangitis
(PSC). The aim of this study was to evaluate diagnostic methods for malignancy in
biliary strictures in conjunction with endoscopic retrograde cholangiopancreaticography
(ERCP).
Patients and Methods: Bile duct strictures were identified during ERCP in 57 patients, who were thus included
in the present study. Brush samples from the strictures were taken for cytology and
for evaluation of DNA content by flow cytometry. The tumor markers CA19-9 and CEA
were determined both in serum and bile fluid. Two independent radiologists evaluated
all cholangiograms. The diagnostic sensitivity, specificity, and accuracy of each
diagnostic method were evaluated separately and in combination.
Results: 32 patients were found to have malignant strictures and when the four methods: brush
cytology, DNA analysis, serum CA19-9 and serum CEA were combined, a diagnostic sensitivity
of 88 % and specificity of 80 % were reached. Seven of the 20 patients with PSC were
found also to suffer from cholangiocarcinoma, yielding a sensitivity and specificity
of 100 % and 85 %, respectively. Analyses of CA19-9 and CEA in bile fluid had no diagnostic
significance.
Conclusion: An ERCP procedure with brush cytology, a DNA analysis, combined with serum analysis
of CA19-9 and CEA, can increase the possibility of distinguishing between malignant
and benign biliary strictures, especially in PSC patients.
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B. Lindberg, M.D.
Department of Diagnostic Radiology · Karolinska Institutet at Huddinge University
Hospital
14186 Stockholm · Sweden
Phone: + 46-8-58580837
Fax: + 46-8-7114840
Email: bo.lindberg@cfss.ki.se