Biliary Cytodiagnosis Bile Sampling for Cytology

CA 19–9 and CE A are unreliable markers for cholangiocarcinoma in patients with primary sclerosing cholangitis

“…Consequently, other diagnostic procedures have been tried in this situation to improve the diagnostic accuracy in the detection of cholangiocarcinoma in these patients. Endoscopic brush cytology (16,17) and measurements of tumor markers have been added to the list of diagnostic tests for concomitant CC in patients with PSC (10,19). CA 19-9 and CEA are oncofetal antigens, found in high concentrations in the fetal small intestine and in gastrointestinal tumors.…”

“…The currently available morphological techniques used in cholangiocarcinoma diagnostics in PSC that is, computerized tomography, ultrasonography and magnetic resonance, have produced disappointing results in the discrimination of PSC alone from PSC with associated CC. Endoscopic brush cytology obtained during endoscopic retrograde cholangiopancreatography (ERCP), with bile duct brushing, has been shown to be of value in the detection of CC in patients with pre-existing PSCl (16,17). When the location of the CC is extrahepatic, repeated brushing of the bile ducts has been used to improve the diagnostic accuracy of CC and negative brush cytology reduces the risk of extrahepatical CC to 43% (17).…”

Differential diagnosis of intrahepatic bile duct dilatation without demonstrable mass on ultrasonography or CT: Benign versus malignancy

“…Furthermore, tumor masses are often not identifiable by CT, US or MR. Endoscopic approaches are also of limited use in tissue diagnosis because of the desmoplastic nature of these cancers. Indeed, bile cytology obtained by endoscopic retrograde cholangiography has a sensitivity of only 30–50%, 15–18 endobiliary brush cytology 50–66% 19,20 and endoscopic transpapillary biopsy 53–86% 9,21 , 22 for detecting cholangiocarcinoma. Because of problems involved in obtaining a tissue diagnosis, treatment and management decisions for patients with biliary strictures that might be malignant are problematic.…”

Cholangiocarcinoma Associated With Hypercalcaemia and Ascites Presenting as Sclerosing Cholangitis

“…Pointers to the development of cholangiocarcinoma in PSC 2 may be a sudden clinical deterioration and appreciably dilated intrahepatic bile duct. Bile brush cytology may also be able to detect cholangiocarcinoma in some patients 3 . The prognosis in cholangiocarcinoma is poor, but treatment may be either palliative, using stents, or curative, with surgery and/or radiotherapy 4 …”