Value of brush cytology for optimal timing of liver transplantation in primary sclerosing cholangitis.
BACKGROUND AND AIMS
Primary sclerosing cholangitis is associated with a high risk of cholangiocarcinoma. Here, we investigated the value of surveillance for dysplasia using brush cytology, to determine the optimal timing of liver transplantation in primary sclerosing cholangitis. We compared our preoperative findings, with the final explanted liver histopathology.


METHODS
126 consecutive patients were transplanted for primary sclerosing cholangitis from 1984 to 2012. Patients were divided into two groups: symptomatic (n=91), and asymptomatic (n=35).


RESULTS
Brush cytology was available for 101 patients; 66 symptomatic and 35 asymptomatic. Suspicious cytological findings were found in nine patients (14%) in the symptomatic group and 17 (49%) in the asymptomatic group. DNA flow cytometry was available for 49 patients (25 symptomatic, 24 asymptomatic), with aneuploidy detected in six patients (24%) in the symptomatic group and 15 (63%) in the asymptomatic group. Explanted liver histology showed biliary dysplasia or cholangiocarcinoma in 11 symptomatic patients (12%) and 15 asymptomatic patients (43%). A combination of cytological and DNA flow cytometry findings resulted in a test sensitivity of 68%, with a specificity of 86%. Ten-year survival in the asymptomatic group was 91%.


CONCLUSIONS
Dysplasia surveillance using brush specimens may help to select those patients likely to benefit from early liver transplantation. It remains unclear as to whether surveillance with brush cytology improves long-term survival, but there is presently no better method with which to predict transplantation timing.
['Vannas|Marko J|MJ|', 'Boyd|Sonja|S|', 'Färkkilä|Martti A|MA|', 'Arola|Johanna|J|', 'Isoniemi|Helena|H|']
D000328:Adult D001650:Bile Duct Neoplasms D001659:Biliary Tract D006528:Carcinoma, Hepatocellular D018281:Cholangiocarcinoma D002760:Cholangiopancreatography, Endoscopic Retrograde D015209:Cholangitis, Sclerosing D003581:Cytodiagnosis D003937:Diagnosis, Differential D004847:Epithelial Cells D005260:Female D005387:Finland D006801:Humans D053208:Kaplan-Meier Estimate D008113:Liver Neoplasms D016031:Liver Transplantation D008297:Male D008875:Middle Aged D012042:Registries D012680:Sensitivity and Specificity
brush cytology liver transplantation primary sclerosing cholangitis cholangiocarcinoma