Format

Send to

Choose Destination
Gastrointest Endosc. 2014 May;79(5):783-9. doi: 10.1016/j.gie.2013.09.015. Epub 2013 Oct 18.

Diagnostic yield of bile duct brushings for cholangiocarcinoma in primary sclerosing cholangitis: a systematic review and meta-analysis.

Author information

1
Department of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA.
2
Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
3
Department of Internal Medicine, University of Connecticut Medical Center, Farmington, Connecticut, USA.

Abstract

BACKGROUND:

The most ominous adverse event of primary sclerosing cholangitis (PSC) is development of cholangiocarcinoma (CCA). There is a wide variation in the reported diagnostic yield of bile duct brush cytology in PSC strictures.

OBJECTIVE:

To determine the diagnostic utility of biliary brush cytology for CCA detection in patients with PSC.

DESIGN:

Meta-analysis. Systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies published up to December 2012.

SETTING:

Meta-analysis of diagnostic parameters.

PATIENTS:

A total of 747 patients in studies (both retrospective and prospective) in which histopathologic correlation of CCA was available.

INTERVENTION:

Meta-analysis. Construction of 2 × 2 contingency data.

MAIN OUTCOME MEASUREMENTS:

Sensitivity, specificity, likelihood ratio, and pooled diagnostic odds ratio.

RESULTS:

The search yielded 54 studies of which 11, involving 747 patients, were included in our meta-analysis. The pooled sensitivity and specificity of bile duct brushings for a diagnosis of CCA in patients with PSC were 43% (95% confidence interval [CI], 35%-52%) and 97% (95% CI, 95%-98%), respectively. The pooled diagnostic odds ratio to detect CCA was 20.23 (95% CI, 8.75-46.79). The heterogeneity indices of χ(2) statistics, I(2) measure of inconsistency, and the Cochran Q test were 0.156, 14.4, and 30.5%, respectively. Visual inspection of the funnel plot showed low potential for publication bias.

LIMITATIONS:

Inclusion of low-quality studies, study heterogeneity.

CONCLUSION:

Our study suggests that bile duct brushing is a simple and highly specific technique for detection of CCA in patients with PSC. However, the modest sensitivity from bile duct brushing precludes its utility as a diagnostic tool for early detection of CCA in patients with PSC.

PMID:
24140129
DOI:
10.1016/j.gie.2013.09.015
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center