Monitoring dominant strictures in primary sclerosing cholangitis with brush cytology and FDG-PET
2014 (English)In: J Hepatol, Vol. 61, no 6, 1352-7 p.Article in journal (Refereed) Published
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.
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
IdentifiersURN: urn:nbn:se:umu:diva-110928ISBN: 1600-0641 (Electronic) 0168-8278 (Linking)OAI: oai:DiVA.org:umu-110928DiVA: 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 9.2015-10-292015-10-292015-10-29