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

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.