The demonstration of a mass lesion with

characteristic imaging features (i.e., malignant appearing mass with delayed venous phase enhancement) has virtually a 100% sensitivity and specificity for the diagnosis of CCA.122 However, mass lesions are unusual in early stage CCA, and in a large study ultrasonography, computerized tomography and magnetic resonance imaging studies yielded an overall limited positive predictive value of 48%, 38%, and 40%, respectively, in identifying CCA in patients with PSC.122 Other than identifying ductal obstruction, direct cholangiography by ERCP and indirect cholangiography by magnetic resonance studies have net overall positive predictive values AZD6244 mw for CCA of only 23% and 21%, respectively.122 The ability to more directly visualize the bile duct via cholangioscopy and/or intraductal US are promising technologies for the diagnosis of CCA in PSC,5, 124 but have not yet been tested in large patient populations nor validated by multiple studies. Unfortunately, conventional brush cytology obtained via endoscopic retrograde or percutaneous cholangiography has a limited sensitivity albeit excellent specificity for the diagnosis of CCA in PSC. The sensitivity in the literature ranges from

18%–40% in large studies.11, 122, 123, 125, 126 The specificity for a positive conventional cytology is virtually 100%. Recently, the demonstration of polysomy (duplication of two or more chromosomes) in ≥5 DMXAA cells by fluorescent in situ hybridization (FISH) of cytologic specimens has demonstrated a sensitivity of 41% and a specificity of 98% for the diagnosis of CCA in PSC patients125; a positive FISH test doubled the sensitivity of conventional cytology in this report. In a small study of 61 patients, the finding of high grade dysplasia was highly sensitive for the diagnosis of CCA (sensitivity of 73% and specificity of 95%).126 The FISH-based and dysplasia-based approaches have yet to be validated by additional

centers. The role of [18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in the diagnosis of CCA in PSC remains controversial.123, 127, 128 It should be noted that inflammation can yield false positive PET scans a potential pitfall in PSC. Many physicians desire guidelines for the surveillance of CCA in PSC patients. Surveillance Selleck Staurosporine strategies are predicated on the availability of highly sensitive diagnostic and cost-effective modalities, effective treatment strategies for patients found to have the disease, and patient acceptance of the diagnostic tests and treatment. Once the above criteria have been met, longitudinal studies must demonstrate a decrease in death from the disease. Inadequate information exists regarding the utility of screening for CCA in PSC; in the absence of evidence based information, many clinicians screen patients with an imaging study plus a CA 19-9 at annual intervals.