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Suspicious brush cytology is an indication for liver transplantation evaluation in primary sclerosing cholangitis

World Journal of Gastroenterology 2017年第33期23卷 6147-6154页

作者： Sonja Boyd Marko Vannas Kalle Jokelainen Helena Isoniemi Heikki Makisalo Martti A Farkkila johanna arola Department of Pathology University of Helsinki and Helsinki University Hospital Transplantation and Liver Surgery Clinic University of Helsinki and Helsinki University Hospital Clinic of Gastroenterology University of Helsinki and Helsinki University Hospital

AIM To investigate markers for high-grade dysplasia for the optimal timing of liver transplantation in patients with primary sclerosing cholangitis(PSC).METHODS Earlier data support a dysplasia-carcinoma sequence,even low-to high-grade dysplasia,in PSC-associated cholangiocarcinoma(CCA). Surveillance using endoscopic retrograde cholangiography(ERC) and brush cytology aims to detect cases of biliary dysplasia,and liver transplantation is an option in cases with suspicion of malignancy in brushing. This study investigated markers to identify patients with highgrade biliary dysplasia for optimal timing in early liver transplantation. Patients undergoing surveillance using ERC and brush cytology during 2008-2014 and who were diagnosed with biliary dysplasia in explanted liver or CCA until February 2016 were included in the study. Demographic data,cholangiography findings,laboratory values,cytological morphology and DNA ploidy were *** Thirty PSC patients had biliary neoplasia in the explanted liver during the study period. Sixteen of these patients had low-grade dysplasia,10 patients had high-grade dysplasia,and 4 patients had CCA. Fifteen PSC patients diagnosed with CCA were not transplanted. Patients with low-grade dysplasia were younger. Alkaline phosphatase or carcinoembryonic antigen values did not differ between groups during surveillance,but carbohydrate antigen 19-9 was higher in CCA patients. No difference in PSC duration,ERC scores,suspicious cytology,or ploidy analysis was found between groups. No difference was observed between fibrosis stage in explanted livers. Low-and high-grade dysplasia could not be differentiated before liver transplantation based on liver enzymes,tumour markers,ERC scores,brush cytology or DNA *** Repeated suspicion of neoplasia in brush cytology should be an indication for evaluations of liver transplantation prior to the development of CCA.

关键词： Endoscopic retrograde cholangiography Brush cytology Cholangiocarcinoma Biliary dysplasia

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