title: Utility of bile duct brushings for the early detection of cholangiocarcinoma in patients with primary sclerosing cholangitis.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Moff
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Clark
authors.forename: Anirban
authors.initials: A
authors.lastname: Maitra
authors.forename: Akhilesh
authors.initials: A
authors.lastname: Pandey
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Thuluvath
mesh_terms: D000328:Adult; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000209:etiology; D001652:Bile Ducts / Q000166:cytology* / Q000473:pathology; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000175:diagnosis* / Q000209:etiology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000150:complications*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013048:Specimen Handling; D016896:Treatment Outcome