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Recall processes for biliary cytology in primary sclerosing cholangitis

Eaton, John E.; Gossard, Andrea A.; Talwalkar, Jayant A.

Current Opinion in Gastroenterology: May 2014 - Volume 30 - Issue 3 - p 287–294
doi: 10.1097/MOG.0000000000000055
BILIARY TRACT: Edited by Gregory J. Gores
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Purpose of review Patients with primary sclerosing cholangitis (PSC) are at an increased risk for cholangiocarcinoma (CCA). Distinguishing benign from malignant biliary strictures with routine biliary cytology in this population is challenging. In this review, we examine the strengths and limitations of biliary cytology, review the application of other techniques to help minimize these limitations and present a pragmatic approach to address biliary cytology findings when encountered in PSC.

Recent findings Limitations of biliary cytology and other diagnostic studies have driven the development of new techniques and applications of existing technologies to improve our ability to diagnose CCA in PSC. Polysomy when detected on fluorescence in-situ hybridization (FISH) is an independent predictor for the development of CCA. The application of imaging techniques and serologic testing such as carbohydrate antigen 19-9 may further enhance our ability to risk stratify patients. Recent studies suggest that proteomics may allow for the identification of novel biomarkers that could enhance our ability to detect CCA.

Summary Given the inherent challenge of establishing a diagnosis of CCA, providers should apply a multifaceted approach that involves biliary cytology, FISH, serologic testing and advanced imaging techniques when CCA is suspected in patients with PSC.

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

Correspondence to John E. Eaton, MD, Instructor of Medicine, Division of Gastroenterology & Hepatology, Mayo Clinic, 200 First Street S.W., Rochester, Minnesota 55905, USA. Tel: +1 507 284 1825; e-mail: eaton.john@mayo.edu

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins