Bile duct basement membrane thickening in primary sclerosing cholangitis.
OBJECTIVE
Primary sclerosing cholangitis (PSC) is characterized histologically by portal inflammation, bile duct injury and regeneration and concentric periductal fibrosis. Although seen commonly in our experience, the significance of histological thickening of the bile duct basement membrane on periodic acid Schiff (PAS)-positive, diastase-resistant (DPAS) staining has never been analysed formally. In this paper we provide an evidence-based assessment of basement membrane thickening (BMT) reproducibility and diagnostic accuracy.


RESULTS
A total of 128 archived medical liver core biopsies were retrieved and blinded for review by two independent histopathologists. BMT was assessed and designated as absent or present with a grade (G) of G1-G3. The sensitivity of any BMT for PSC was good at 77%, with moderate specificity at 61%. When only G3 BMT was considered positive, the specificity was high at 95% but the sensitivity was poor at 16%. The interobserver agreement (0.69) and consistency (0.72) were good.


CONCLUSIONS
Basement membrane thickening is a reproducible predictor for PSC with good sensitivity and specificity. The presence of G2 and especially G3 BMT showed high specificity and could be regarded as highly predictive of PSC. The presence of more than G1 BMT should be reported and the possibility of PSC should be raised in the differential diagnosis.
Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Richard
R
Colling
Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Clare
C
Verrill
Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Eve
E
Fryer
Department of Oncology, University of Oxford, Oxford, UK.
Christiana
C
Kartsonaki
Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
Lai M
LM
Wang
Medical Sciences Division, University of Oxford, Oxford, UK.
Roger
R
Chapman
Department of Hepatology, Oxford University Hospitals NHS Trust, Oxford, UK.
Naayil
N
Rajabally
Medical Sciences Division, University of Oxford, Oxford, UK.
Kenneth
K
Fleming
D000328:Adult; D000368:Aged; D001485:Basement Membrane / Q000473:pathology*; D001652:Bile Ducts / Q000473:pathology*; D015209:Cholangitis, Sclerosing / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
basement membrane; diagnosis; liver; primary sclerosing cholangitis