title: Diagnostic yield of bile duct brushings for cholangiocarcinoma in primary sclerosing cholangitis: a systematic review and meta-analysis.
abstract: BACKGROUND
  The most ominous adverse event of primary sclerosing cholangitis (PSC) is development of cholangiocarcinoma (CCA). There is a wide variation in the reported diagnostic yield of bile duct brush cytology in PSC strictures.
  
  
  OBJECTIVE
  To determine the diagnostic utility of biliary brush cytology for CCA detection in patients with PSC.
  
  
  METHODS
  Meta-analysis. Systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies published up to December 2012.
  
  
  METHODS
  Meta-analysis of diagnostic parameters.
  
  
  METHODS
  A total of 747 patients in studies (both retrospective and prospective) in which histopathologic correlation of CCA was available.
  
  
  METHODS
  Meta-analysis. Construction of 2 × 2 contingency data.
  
  
  METHODS
  Sensitivity, specificity, likelihood ratio, and pooled diagnostic odds ratio.
  
  
  RESULTS
  The search yielded 54 studies of which 11, involving 747 patients, were included in our meta-analysis. The pooled sensitivity and specificity of bile duct brushings for a diagnosis of CCA in patients with PSC were 43% (95% confidence interval [CI], 35%-52%) and 97% (95% CI, 95%-98%), respectively. The pooled diagnostic odds ratio to detect CCA was 20.23 (95% CI, 8.75-46.79). The heterogeneity indices of χ(2) statistics, I(2) measure of inconsistency, and the Cochran Q test were 0.156, 14.4, and 30.5%, respectively. Visual inspection of the funnel plot showed low potential for publication bias.
  
  
  CONCLUSIONS
  Inclusion of low-quality studies, study heterogeneity.
  
  
  CONCLUSIONS
  Our study suggests that bile duct brushing is a simple and highly specific technique for detection of CCA in patients with PSC. However, the modest sensitivity from bile duct brushing precludes its utility as a diagnostic tool for early detection of CCA in patients with PSC.
authors.affiliation: Department of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Guru
authors.initials: G
authors.lastname: Trikudanathan
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Department of Internal Medicine, University of Connecticut Medical Center, Farmington, Connecticut, USA.
authors.forename: Basile
authors.initials: B
authors.lastname: Njei
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
mesh_terms: D001650:Bile Duct Neoplasms / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D018281:Cholangiocarcinoma / Q000473:pathology*; D015209:Cholangitis, Sclerosing / Q000473:pathology*; D003581:Cytodiagnosis; D006801:Humans; D012680:Sensitivity and Specificity