Change search
ReferencesLink to record
Permanent link

Direct link
Monitoring dominant strictures in primary sclerosing cholangitis with brush cytology and FDG-PET
Show others and affiliations
2014 (English)In: J Hepatol, Vol. 61, no 6, 1352-7 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Despite a high risk of cholangiocellular adenocarcinoma (CCA) it is unclear how surveillance of patients with primary sclerosing cholangitis (PSC) should be performed. METHODS: We evaluated a follow-up algorithm of brush cytology and positron emission tomography/computed tomography with [(18)F] fluorodeoxyglucose ([(18)F]FDG-PET/CT), measured as maximum standardized uptake values, normalized to the liver background (SUVmax/liver) at 180 min, in PSC patients with dominant bile duct strictures. RESULTS: Brush cytology with high grade dysplasia (HGD) was detected in 12/70 patients (17%), yielding a diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 56%, 89%, 75%, and 88%, respectively. Preemptive liver transplantations due to repeated HGD before manifest CCA were performed in six patients. Receiver operating characteristic (ROC) analysis of [(18)F]FDG uptake showed that a SUVmax/liver quotient of 3.3 was able to discriminate between CCA and non-malignant disease with a sensitivity, specificity, PPV and NPV for CCA of 89%, 92%, 62%, 98%, respectively. A SUVmax/liver >3.3 detected CCA in 8/9 patients whereas a quotient <2.4 excluded CCA. Combining brush cytology and quantitative [(18)F]FDG-PET/CT yielded a sensitivity for HGD and/or CCA of 100% and a specificity of 88%. CONCLUSION: Early detection of HGD before manifest CCA is feasible with repeated brush cytology and may allow for preemptive liver transplantation. [(18)F]FDG-PET/CT has a high sensitivity for manifest CCA and a negative scan indicates a non-malignant state of the disease. Brush cytology and [(18)F]FDG-PET/CT are complementary in monitoring and managing PSC patients with dominant strictures.

Place, publisher, year, edition, pages
2014. Vol. 61, no 6, 1352-7 p.
Keyword [en]
Adenocarcinoma/diagnosis/pathology/radionuclide imaging, Adult, Aged, Aged, 80 and over, Bile Duct Neoplasms/diagnosis/pathology/radionuclide imaging, Bile Ducts, Intrahepatic, Cholangiocarcinoma/diagnosis/pathology/radionuclide imaging, Cholangitis, Sclerosing/*pathology/*radionuclide imaging, Constriction, Pathologic/pathology/radionuclide imaging, Cytological Techniques/*methods, *Disease Progression, Feasibility Studies, Female, *Fluorodeoxyglucose F18, Follow-Up Studies, Humans, Liver Transplantation, Male, Middle Aged, Positron-Emission Tomography/*methods, Prospective Studies, Sensitivity and Specificity, Biliary dysplasia, Brush cytology, Cholangiocellular adenocarcinoma, Endoscopic retrograde cholangiography, Positron emission tomography, [(18)f]fdg
National Category
Basic Medicine
URN: urn:nbn:se:umu:diva-110928ISBN: 1600-0641 (Electronic) 0168-8278 (Linking)OAI: diva2:865854

Sangfelt, Per Sundin, Anders Wanders, Alkwin Rasmussen, Ib Karlson, Britt-Marie Bergquist, Annika Rorsman, Fredrik eng Evaluation Studies Research Support, Non-U.S. Gov't Netherlands 2014/08/12 06:00 J Hepatol. 2014 Dec;61(6):1352-7. doi: 10.1016/j.jhep.2014.07.032. Epub 2014 Aug 9.

Available from: 2015-10-29 Created: 2015-10-29 Last updated: 2015-10-29

Open Access in DiVA

No full text

Other links

Search in DiVA

By author/editor
Wanders, A.
Basic Medicine

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 15 hits
ReferencesLink to record
Permanent link

Direct link