title: Screening primary sclerosing cholangitis and biliary dysplasia with endoscopic retrograde cholangiography and brush cytology: risk factors for biliary neoplasia.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: University of Helsinki and Helsinki University Hospital, HUSLAB Department of Pathology, Helsinki, Finland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Boyd
authors.affiliation: University of Helsinki and Clinic of Gastroenterology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tenca
authors.affiliation: University of Helsinki and Clinic of Gastroenterology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Kalle
authors.initials: K
authors.lastname: Jokelainen
authors.affiliation: Department of Surgery, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki, Finland.
authors.forename: Harri
authors.initials: H
authors.lastname: Mustonen
authors.affiliation: University of Helsinki and Helsinki University Hospital - Jorvi, Espoo, Finland.
authors.forename: Leena
authors.initials: L
authors.lastname: Krogerus
authors.affiliation: University of Helsinki and Helsinki University Hospital, HUSLAB Department of Pathology, Helsinki, Finland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Arola
authors.affiliation: University of Helsinki and Clinic of Gastroenterology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Martti A
authors.initials: MA
authors.lastname: Färkkilä
mesh_terms: D000328:Adult; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D001652:Bile Ducts / Q000473:pathology*; D018281:Cholangiocarcinoma / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D003581:Cytodiagnosis / Q000379:methods / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D000637:Transaminases / Q000032:analysis
chemical_list: D000637:Transaminases